A strategy of computed tomography, followed by laparoscopy and laparoscopic ultrasonography, for the assessment of resectability of pancreatic cancer, results in lower costs than other imaging techniques, claim researchers from Boston, Massachusetts, USA.
The team evaluated the cost-effectiveness of imaging strategies for the assessment of resectability in patients with pancreatic cancer.
The results of the study were reported in the October issue of Radiology.
A decision model was developed to calculate costs and benefits (survival) accruing to hypothetical cohorts of patients with known or suspected pancreatic cancer.
Results were presented as cost per life-year gained under various scenarios and assumptions of diagnostic test characteristics, surgical mortality, disease characteristics, and costs.
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.
| A strategy of CT, laparoscopy, and laparoscopic US is most cost-effective.
This strategy was significantly more cost-effective than CT followed by magnetic resonance (MR) imaging. It was also 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 found to be 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.
Pamela M. McMahon, of the Massachusetts General Hospital, Boston, concluded on behalf of her colleagues, "Most available imaging tests for assessing resectability of pancreatic cancer do not differ in effectiveness.
"However, 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."