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Pancreatic Cancer: Cost-Effectiveness of Imaging Technologies for Assessing Resectability¹

¹ From the Decision Analysis and Technology Assessment Group, Department of Radiology (P.M.M., E.F.H., G.S.G.), Department of Surgery (C.F.d.C.), and Department of Oncology (J.C.), Massachusetts General Hospital, Zero Emerson Pl, Suite 2H, Boston, MA 02114; PhD Program in Health Policy, Harvard University, Cambridge, Mass (P.M.M.); and Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass (G.S.G.). Received October 16, 2000; revision requested December 15; revision received February 8, 2001; accepted April 16. Address correspondence to G.S.G. (e-mail: scott@the-data-group.org).

PURPOSE: To evaluate the cost-effectiveness of imaging strategies for the assessment of resectability in patients with pancreatic cancer.

MATERIALS AND METHODS: A decision model was developed to calculate costs and benefits (survival) accruing to hypothetical cohorts of patients with known or suspected pancreatic cancer. Results are presented as cost per life-year gained under various scenarios and assumptions of diagnostic test characteristics, 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 (US) had an incremental cost-effectiveness ratio of $87,502 per life-year gained, compared with best supportive care. This strategy was significantly more cost-effective than CT followed by magnetic resonance (MR) imaging and was significantly less expensive than other imaging strategies while providing a statistically and clinically insignificant difference in life-year gains. 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-effectiveness ratio of $64,401 per life-year gained, compared to best supportive care.

CONCLUSION: Most available imaging tests for assessing resectability of pancreatic cancer do not differ in effectiveness, but a strategy of CT, laparoscopy, and laparoscopic US would consistently result in significantly lower costs than other imaging tests under a wide range of scenarios.

Index terms: Cost-effectiveness • Pancreas, neoplasms, 770.321 • Radiology and radiologists, socioeconomic issues

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