Intraductal papillary mucinous neoplasms of the pancreas – a cost-effectiveness analysis of management strategies for the branch-duct subtype
(2018) In HPB 20(12). p.1206-1214- Abstract
Background: Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) presents a clinical conundrum. Rigorous long-term surveillance or surgical resection is recommended. The economic consequences of the management have not been fully investigated. Methods: A Markov decision model compared 4 strategies for low-risk BD-IPMN: I = upfront total pancreatectomy, II = upfront partial pancreatectomy, III = initial surveillance, IV = watchful waiting. Surveillance was based on the Swedish Guidelines for Pancreatic Cancer. Probabilities and costs were obtained from the participating unit and from the scientific literature. The incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed by varying... (More)
Background: Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) presents a clinical conundrum. Rigorous long-term surveillance or surgical resection is recommended. The economic consequences of the management have not been fully investigated. Methods: A Markov decision model compared 4 strategies for low-risk BD-IPMN: I = upfront total pancreatectomy, II = upfront partial pancreatectomy, III = initial surveillance, IV = watchful waiting. Surveillance was based on the Swedish Guidelines for Pancreatic Cancer. Probabilities and costs were obtained from the participating unit and from the scientific literature. The incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed by varying relevant parameters. Survival was reported in quality-adjusted life-years (QALYs). Results: Strategy III was the most cost-effective strategy with an ICER of €31 682 compared to strategy IV. Strategy I was the most expensive but yielded the best QALY (9.32). Total number of years, annual risk of pancreatic cancer and annual risk of a low-risk BD-IPMN turning into a high-risk lesion had the greatest impact in the model. Conclusions: Initial surveillance seems to be the most cost-effective strategy in the management of low-risk asymptomatic BD-IPMN. However, the possibility of personalized approaches remains to be investigated.
(Less)
- author
- Aronsson, Linus LU ; Ansari, Daniel LU ; Andersson, Bodil LU ; Persson, Ulf LU ; Fridhammar, Adam and Andersson, Roland LU
- organization
- publishing date
- 2018-12
- type
- Contribution to journal
- publication status
- published
- subject
- in
- HPB
- volume
- 20
- issue
- 12
- pages
- 1206 - 1214
- publisher
- Elsevier
- external identifiers
-
- scopus:85050620776
- pmid:30064727
- ISSN
- 1365-182X
- DOI
- 10.1016/j.hpb.2018.06.1801
- language
- English
- LU publication?
- yes
- id
- 68914f99-a0e3-4c98-b86b-8b4aa16158b8
- date added to LUP
- 2018-09-24 14:46:34
- date last changed
- 2024-07-22 22:17:14
@article{68914f99-a0e3-4c98-b86b-8b4aa16158b8, abstract = {{<p>Background: Branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) presents a clinical conundrum. Rigorous long-term surveillance or surgical resection is recommended. The economic consequences of the management have not been fully investigated. Methods: A Markov decision model compared 4 strategies for low-risk BD-IPMN: I = upfront total pancreatectomy, II = upfront partial pancreatectomy, III = initial surveillance, IV = watchful waiting. Surveillance was based on the Swedish Guidelines for Pancreatic Cancer. Probabilities and costs were obtained from the participating unit and from the scientific literature. The incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed by varying relevant parameters. Survival was reported in quality-adjusted life-years (QALYs). Results: Strategy III was the most cost-effective strategy with an ICER of €31 682 compared to strategy IV. Strategy I was the most expensive but yielded the best QALY (9.32). Total number of years, annual risk of pancreatic cancer and annual risk of a low-risk BD-IPMN turning into a high-risk lesion had the greatest impact in the model. Conclusions: Initial surveillance seems to be the most cost-effective strategy in the management of low-risk asymptomatic BD-IPMN. However, the possibility of personalized approaches remains to be investigated.</p>}}, author = {{Aronsson, Linus and Ansari, Daniel and Andersson, Bodil and Persson, Ulf and Fridhammar, Adam and Andersson, Roland}}, issn = {{1365-182X}}, language = {{eng}}, number = {{12}}, pages = {{1206--1214}}, publisher = {{Elsevier}}, series = {{HPB}}, title = {{Intraductal papillary mucinous neoplasms of the pancreas – a cost-effectiveness analysis of management strategies for the branch-duct subtype}}, url = {{http://dx.doi.org/10.1016/j.hpb.2018.06.1801}}, doi = {{10.1016/j.hpb.2018.06.1801}}, volume = {{20}}, year = {{2018}}, }