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. 2015 Feb;17(2):131-9.
doi: 10.1111/hpb.12325. Epub 2014 Aug 15.

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

Thejus T Jayakrishnan  1 , Hasan Nadeem, Ryan T Groeschl, Ben George, James P Thomas, Paul S Ritch, Kathleen K Christians, Susan Tsai, Douglas B Evans, Sam G Pappas, T Clark Gamblin, Kiran K Turaga
Affiliations

Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

Thejus T Jayakrishnan et al. HPB (Oxford). 2015 Feb.

Abstract

Objectives: Laparoscopy is recommended to detect radiographically occult metastases in patients with pancreatic cancer before curative resection. This study was conducted to test the hypothesis that diagnostic laparoscopy (DL) is cost-effective in patients undergoing curative resection with or without neoadjuvant therapy (NAT).

Methods: Decision tree modelling compared routine DL with exploratory laparotomy (ExLap) at the time of curative resection in resectable cancer treated with surgery first, (SF) and borderline resectable cancer treated with NAT. Costs (US$) from the payer's perspective, quality-adjusted life months (QALMs) and incremental cost-effectiveness ratios (ICERs) were calculated. Base case estimates and multi-way sensitivity analyses were performed. Willingness to pay (WtP) was US$4166/QALM (or US$50,000/quality-adjusted life year).

Results: Base case costs were US$34,921 for ExLap and US$33,442 for DL in SF patients, and US$39,633 for ExLap and US$39,713 for DL in NAT patients. Routine DL is the dominant (preferred) strategy in both treatment types: it allows for cost reductions of US$10,695/QALM in SF and US$4158/QALM in NAT patients.

Conclusions: The present analysis supports the cost-effectiveness of routine DL before curative resection in pancreatic cancer patients treated with either SF or NAT.

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Figures

Figure 1
Figure 1
Variation in the cost-effectiveness of diagnostic laparoscopy in pancreatic cancer with probability for advanced disease and sensitivity of laparoscopy. (Willingness to pay US$50 000/quality-adjusted life year.) SF, surgery first paradigm; NAT, neoadjuvant therapy paradigm in borderline resectable pancreatic cancer
Figure 2
Figure 2
Variation in the cost-effectiveness of diagnostic laparoscopy in pancreatic cancer with probability for advanced disease and sensitivity of laparoscopy. (Willingness to pay US$100 000/quality-adjusted life year.) SF, surgery first paradigm; NAT, neoadjuvant therapy paradigm in borderline resectable pancreatic cancer
See this image and copyright information in PMC

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