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Cost-effectiveness of Treatment Strategies for Pancreatic Head Adenocarcinoma and Potential Opportunities for Improvement

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Generally dismal outcomes have led to a nihilistic attitude toward treating pancreatic cancer, while fiscal constraints have increased scrutiny of treatments costs. Our objective was to compare the cost-effectiveness of various treatment strategies for resectable pancreatic head adenocarcinoma, and to identify opportunities for improved cost effectiveness.

Methods

A decision model compared 6 strategies: no treatment, radiotherapy only, chemotherapy only, chemotherapy plus radiotherapy, surgery alone, and surgery plus adjuvant therapy. Outcomes and probabilities were identified using the National Cancer Data Base, the American Cancer Society National Surgical Quality Improvement Program, and the literature. Costs were estimated using Medicare payment. Incremental cost-effectiveness ratios (ICERs) were calculated, and sensitivity analyses were performed by varying potentially modifiable parameters of the model. Survival was reported in quality-adjusted life-months (QALMs).

Results

Surgery plus adjuvant therapy, chemotherapy alone, and no treatment were the only viable strategies in terms of cost effectiveness. Surgery plus adjuvant therapy versus no treatment demonstrated an incremental cost-effectiveness ratio (ICER) of $7,663/QALM. Theoretically increasing survival in node-negative, margin-negative patients from 14 to 22 QALMs produced the largest reduction in the ICER for surgery plus adjuvant therapy compared to no treatment ($6,386/QALM), whereas reducing the perioperative mortality from 3 to 1 % had only a marginal effect. The ICER was significantly lower for high-performing centers ($5,991/QALM) than for low-performing centers ($9,144/QALM).

Conclusions

Surgery plus adjuvant therapy for resectable pancreatic head adenocarcinoma extends survival, but at considerable expense. Significant cost reductions could be realized by improving treatment outcomes to levels of high-performing centers and development of increasingly effective adjuvant therapies.

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Acknowledgment

The authors wish to acknowledge the expert scientific editing of Stephanie Deming and support from the National Institutes of Health through The University of Texas MD Anderson Cancer Center’s Support Grant CA 106672.

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Authors and Affiliations

  1. Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Daniel E. Abbott MD

  2. Surgical Outcomes and Quality Improvement Center, Department of Surgery, and Northwestern Institute for Comparative Effectiveness Research in Oncology, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow MD, David J. Bentrem MD & Karl Y. Bilimoria MD, MS

  3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Scott B. Cantor PhD

  4. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jason B. Fleming MD

  5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Gauri R. Varadhachary MD, MBBS

  6. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christopher Crane MD

  7. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Ryan P. Merkow MD & Karl Y. Bilimoria MD, MS

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  1. Daniel E. Abbott MD
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  2. Ryan P. Merkow MD
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  8. Karl Y. Bilimoria MD, MS
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Correspondence to Karl Y. Bilimoria MD, MS.

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Abbott, D.E., Merkow, R.P., Cantor, S.B. et al. Cost-effectiveness of Treatment Strategies for Pancreatic Head Adenocarcinoma and Potential Opportunities for Improvement. Ann Surg Oncol 19, 3659–3667 (2012). https://doi.org/10.1245/s10434-012-2610-1

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  • DOI: https://doi.org/10.1245/s10434-012-2610-1

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