A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma

OBJECTIVE: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy of nonperitumoral (NPT) lymph nodes (LN) can be helpful in preoperat ive. staging of pancreatic head adenocarcinoma. The economic impact of this staging strategy has not yet been described. The aim of this study was to apply a decision analysis model to compare the costs of three approaches to the management of nonmetastatic pancreatic head adenocarcinoma: EUS FNA ve rb sus CT-guided FNA versus surgery. A cost minimization approach was emplo yed, as viewed from the perspective of the payer. METHODS: A decision analysis model was designed using DATA Version 3.5, tak ing the entry criteria as "resectable" pancreatic head adenocarcinoma as de termined by helical CT. Detection of metastatic NPT LN on FNA signified unr esectability and obviated the need for surgery. Baseline probabilities were varied through plausible ranges using sensitivity analysis. Cost inputs we re based on Medicare professional plus facility fees. The endpoint was cost of management per patient. RESULTS: EUS FNA was the least costly strategy ($15,938) compared with CT F NA ($16,378) and surgery ($18,723). Sensitivity analysis revealed that EUS FNA remained the least costly option provided the frequency of NPT LN invol vement was >4%; below this value, surgery became the least costly. CONCLUSIONS: EUS INA is the least costly staging strategy in the workup of patients with nonmetastatic pancreatic head adenocarcinoma primarily becaus e of confirmation of NPT LN involvement avoiding unnecessary surgery. These results support performing EUS in patients whose tumors are thought to be resectable on helical CT to enhance NPT LN assessment. (Am J Gastroenterol 2001;96:2651-2656. (C) 2001 by Am. Coll. of Gastroenterology).