Pancreatic cancer: Cost-effectiveness of imaging technologies for assessing resectability

PURPOSE: To evaluate the cost-effectiveness of imaging strategies for the a ssessment of resectability in patients with pancreatic cancer. MATERIALS AND METHODS: A decision model was developed to calculate costs an d benefits (survival) accruing to hypothetical cohorts of patients with kno wn or suspected pancreatic cancer. Results are presented as cost per life-y ear gained under various scenarios and assumptions of diagnostic test chara cteristics, surgical mortality, disease characteristics, and costs. RESULTS: With best estimates for all data inputs, the strategy of computed tomography (CT) followed by laparoscopy and laparoscopic ultrasonography (U S) had an incremental cost-effectiveness ratio of $87,502 per life-year gai ned, compared with best supportive care. This strategy was significantly mo re cost-effective than CT followed by magnetic resonance (MR) imaging and w as significantly less expensive than other imaging strategies while providi ng a statistically and clinically insignificant difference in life-year gai ns. A strategy involving no imaging (immediate surgery) was more expensive but less effective than all imaging strategies. A hypothetical perfect test with cost equal to that of CT followed by MR had an incremental cost-effec tiveness ratio of $64,401 per life-year gained, compared to best supportive care. CONCLUSION: Most available imaging tests for assessing resectability of pan creatic cancer do not differ in effectiveness, but a strategy of CT, laparo scopy, and laparoscopic US would consistently result in significantly lower costs than other imaging tests under a wide range of scenarios.