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Annals of Surgical Oncology

, Volume 20, Issue 7, pp 2197–2203 | Cite as

Frequency and Intensity of Postoperative Surveillance After Curative Treatment of Pancreatic Cancer: A Cost-Effectiveness Analysis

  • Ching-Wei D. Tzeng
  • Daniel E. Abbott
  • Scott B. Cantor
  • Jason B. Fleming
  • Jeffrey E. Lee
  • Peter W. T. Pisters
  • Gauri R. Varadhachary
  • James L. Abbruzzese
  • Robert A. Wolff
  • Syed A. Ahmad
  • Matthew H. G. Katz
Pancreatic Tumors

Abstract

Background

Few data exist to guide oncologic surveillance following curative treatment of pancreatic cancer. We sought to identify a rational, cost-effective postoperative surveillance strategy.

Methods

We constructed a Markov model to compare the cost-effectiveness of 5 postoperative surveillance strategies. No scheduled surveillance served as the baseline strategy. Clinical evaluation and carbohydrate antigen (CA) 19-9 testing without/with routine computed tomography and chest X-ray at either 6- or 3-month intervals served as the 4 comparison strategies of increasing intensity. We populated the model with symptom, recurrence, treatment, and survival data from patients who had received intensive surveillance after multimodality treatment at our institution between 1998 and 2008. Costs were based on Medicare payments (2011 US dollars).

Results

The baseline strategy of no scheduled surveillance was associated with a postoperative overall survival (OS) of 24.6 months and a cost of $3837/patient. Clinical evaluation and CA 19-9 assay every 6 months until recurrence was associated with a 32.8-month OS and a cost of $7496/patient, with an incremental cost-effectiveness ratio (ICER) of $5364/life-year (LY). Additional routine imaging every 6 months incrementally increased total cost by $3465 without increasing OS. ICERs associated with clinic visits every 3 months without/with routine imaging were $127,680 and $294,696/LY, respectively. Sensitivity analyses changed the strategies’ absolute costs but not the relative ranks of their ICERs.

Conclusions

Increasing the frequency and intensity of postoperative surveillance of patients after curative therapy for pancreatic cancer beyond clinical evaluation and CA 19-9 testing every 6 months increases cost but confers no clinically significant survival benefit.

Keywords

Overall Survival National Comprehensive Cancer Network National Comprehensive Cancer Network Carbohydrate Antigen National Comprehensive Cancer Network Guideline 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

We thank Sarah Bronson and Kathryn Carnes for their scientific editing of this manuscript. Supported by the Khalifa Bin Zayed Al Nahyan Foundation and the Various Donor Pancreatic Research Fund at The University of Texas MD Anderson Cancer Center.

Disclosure

None.

Supplementary material

10434_2013_2889_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 34 kb)

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Ching-Wei D. Tzeng
    • 1
  • Daniel E. Abbott
    • 2
  • Scott B. Cantor
    • 3
  • Jason B. Fleming
    • 1
  • Jeffrey E. Lee
    • 1
  • Peter W. T. Pisters
    • 1
  • Gauri R. Varadhachary
    • 4
  • James L. Abbruzzese
    • 4
  • Robert A. Wolff
    • 4
  • Syed A. Ahmad
    • 2
  • Matthew H. G. Katz
    • 1
  1. 1.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Division of Surgical OncologyUniversity of CincinnatiCincinnatiUSA
  3. 3.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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