A Cost Decision Analysis for Diagnosing and Staging
Diagnostic technologies have no major contributory role in the observed continuous increase in health care spendings of Western societies. Although cost-benefit analyses were mainly performed to evaluate therapeutic interventions, the evaluation of different diagnostic procedures became the focus of health technology assessments in recent years. So-called decision trees proved to be a valuable tool for studying cost-effectiveness.
On average 4,000 € have to be spent each month for a patient with pancreatic cancer (PC) when indirect costs are included. Diagnostic imaging accounts for 9% of all costs during hospitalisation.
In more than 80% of PC patients a combination of abdominal US and CT clearly defines the locally progressed or even metastasized state and is associated with limited costs. According to cost-effectiveness models, the combination of CT with EUS, EUS-FNA or laparoscopy was associated with higher costs for diagnosis and staging but reduced total costs by avoiding unnecessary laparotomies in patients with peritoneal carcinomatosis or non-locoregional lymph node metastases. Further studies have to prove cost-effectiveness when state of the art multidetector row CT scanners with very high accuracy rates are combined with complimentary diagnostic modalities.
Screening for pancreatic cancer in high risk populations (familial pancreatic cancer families, hereditary pancreatitis, Peutz-Jeghers syndrome) offers the possibility to detect (pre)malignant pancreatic lesions at an early stage when a curative resection is still possible. Studies demonstrated that screening might be cost-effective only in subgroups of patients with the highest cancer risk. EUS-based screening programmes are hampered by a significant number of false-positive results leading to unnecessary diagnostic and therapeutic procedures contributing to high expenditures.
KeywordsPancreatic Cancer Health Technology Assessment Intraductal Papillary Mucinous Neoplasm Intraductal Papillary Mucinous Neoplasm Resectable Pancreatic Cancer
Multidetector-row computed tomography
Fine needle aspiration
Incremental cost effectiveness ratio
Magnetic resonance imaging
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