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. 2022 Apr;127(4):349-359.
doi: 10.1007/s11547-022-01459-8. Epub 2022 Mar 1.

Cost-effectiveness analysis of including contrast-enhanced ultrasound in management of pancreatic cystic neoplasms

Niccolo' Faccioli  1 , Elena Santi  2 , Giovanni Foti  3 , Mirko D'Onofrio  2
Affiliations

Cost-effectiveness analysis of including contrast-enhanced ultrasound in management of pancreatic cystic neoplasms

Niccolo' Faccioli et al. Radiol Med. 2022 Apr.

Abstract

Purpose: Pancreatic cystic neoplasms (PCN) management consists of non-invasive imaging studies (CT, MRI), with a high resource burden. We aimed to determine the cost-effectiveness of including contrast-enhanced ultrasound (CEUS) in the management of PCN without risk features.

Materials and methods: By using a decision-tree model in a hypothetical cohort of patients, we compared management strategy including CEUS with the latest Fukuoka consensus, European and Italian guidelines. Our strategy for BD-IPMN/MCN < 1 cm includes 1 CEUS annually. For those between 1 and 2 cm, it includes CEUS 4 times/year during the first year, then 3 times/year for 4 years and then annually. For those between 2 and 3 cm, it comprises MRI twice/year during the first one, then alternating 2 CEUS and 1 MRI yearly.

Results: CEUS surveillance is the dominant strategy in all scenarios. CEUS surveillance average cost is 1,984.72 €, mean QALY 11.79 and mean ICER 181.99 €. If willingness to pay is 30,000 €, 45% of patients undergone CEUS surveillance of BDIPMN/MCN < 1 cm would be within budget.

Conclusion: Guidelines strategies are very effective, but costs are relatively high from a policy perspective. CEUS surveillance may be a cost-effective strategy yielding a nearly high QALYs, an acceptable ICER, and a lower cost.

Keywords: Economic evaluation; Incidental pancreatic lesion; Optimal strategy; Quality of life; Surveillance.

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Conflict of interest statement

Niccolò Faccioli, Elena Santi, Giovanni Foti, Mirko D’Onofrio declare that they have no conflict of interest. The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1
Fig. 1
Example of decisional tree for management strategies in BD-IPMN/MCN < 1 cm
Fig. 2
Fig. 2
Plot of cost versus effectiveness for management strategies in BD-IPMN 2–3 cm. The horizontal axis represents the effectiveness and the vertical one the cost. The slope of line that connects the points is determined by their ICER (frontier interventions). Willingness to pay (WTP) set to 30,000€
Fig. 3
Fig. 3
A. Acceptability curve for management strategies in BD-IPMN/MCN < 1 cm. At € 30,000 willingness-to-pay (WTP) threshold, 45% of the simulated trials in the surveillance strategy were within budget. B. Acceptability curve for management strategies in MCN 3–4 cm. At € 30,000 willingness-to-pay (WTP) threshold, 56% of the simulated trials in the surveillance strategy were within budget
See this image and copyright information in PMC

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