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Cost-minimization study into strategies of pancreatic cancer diagnosis

A cost-minimization study, published in November's American Journal of Gastroenterology, illustrates that EUS-FNA is the best initial and the preferred secondary alternative method for the diagnosis of suspected pancreatic cancer.

News image

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Several modalities currently exist for tissue confirmation of suspected pancreatic cancer prior to therapy.

There is a paucity of cost-minimization studies comparing these different biopsy modalities.

Dr Chen and colleagues from Alabama in America undertook a study in order to analyze costs and effectiveness of 4 alternative strategies for diagnosing pancreatic cancer.

The researchers constructed a decision analysis model of patients with suspected pancreatic cancer.

The research team analyzed costs, failure rate, testing characteristics, and complication rates of 4 commonly employed diagnostic modalities:

1) Computerized tomography or ultrasound-guided fine-needle aspiration (CT/US-FNA)

2) Endoscopic retrograde cholangiopancreatography with brushings (ERCP-B)

3) Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA), and

4) Laparoscopic surgical biopsy.

If the first attempt with a particular modality failed, the researchers employed a different modality to identify the most preferable secondary biopsy strategy.

EUS-FNA is the preferred secondary modality in both the setting of and absence of obstructive jaundice
American Journal of Gastroenterology

The research group found that this analysis identified EUS-FNA as the preferred initial modality for the diagnosis of pancreatic cancer.

Resultant expected costs and strategies in decreasing optimality include: 1) EUS-FNA ($1,405), 2) ERCP-B ($1,432), 3) CT/US-FNA ($3,682), and 4) surgery ($17,711).

The researchers found that if a patient presents with obstructive jaundice, decision analysis modeling results in a total expected costs of $1,970 if ERCP-B is successful at the time of biliary stent placement.

The research team performed additional analyses to identify the preferred follow-up modality after a failed alternative method.

The team showed that EUS-FNA is the preferred secondary modality if any of the other 3 modalities failed first, in both the setting of and absence of obstructive jaundice.

In addition, the researchers found that 1- and 2-way sensitivity analysis of the variables show unchanged results over an acceptable range.

Dr Chen concluded, "This cost-minimization study illustrates that EUS-FNA is the best initial and the preferred secondary alternative method for the diagnosis of suspected pancreatic cancer."

He added "In addition to local expertise and availability, costs and diagnostic yield should be considered when choosing an optimal diagnostic strategy."

American Journal of Gastroenterology; 2004: 99 (11): 2223
16 November 2004

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