Cost-effectiveness of Pancreatic Cancer Surveillance in High-Risk Individuals An Economic Analysis

Objective: The aim of the study was to perform an economic analysis to identify the clinical and cost determinants of pancreatic cancer (PC) surveillance in high-risk individuals (HRIs). Methods: AMarkov modelwas created to compare the following 3 strategies: no screening, endoscopic ultrasound (EUS), andmagnetic resonance imaging (MRI) screening. Patients were considered HRIs according to the Cancer of the Pancreas Screening consortium recommendations. Risk for developing PC, survival, and costs datawere obtained from the Surveillance, Epidemiology, and End Results and Medicare databases. Surveillance effectiveness was obtained from a recent meta-analysis. Results: Analysis of a cohort with fivefold relative risk of PC higher than the US population showed thatMRI is the most cost-effective strategy. For those with the highest risk (> similar to 20 relative risk), EUS became the dominant strategy. Our model was impacted by cost and imaging performance, but still cost-effectivewithin the range reported in literature. Threshold analysis showed that if MRI increases greater than US $ 1600, EUS becomes more cost-effective. Once patients reached the age of 76 years, " no screening" was favored. Both surveillance strategieswere cost-effective over awide range of willingness to pay. Conclusions: Abdominal imaging followed by pancreatectomy is costeffective to prevent PC in HRIs, favoring MRI in moderate risk cases but EUS in those with highest risk.