Is screening for pancreatic cancer in high-risk groups cost-effective? Experience from a Danish national screening program

TY - JOUR

T1 - Is screening for pancreatic cancer in high-risk groups cost-effective?

T2 - Experience from a Danish national screening program

AU - Jøergensen, Maiken Thyregod

AU - Gerdes, Anne-Marie

AU - Sørensen, Jan

AU - Schaffalitzky de Muckadell, Ove

AU - Mortensen, Michael Bau

N1 - Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - OBJECTIVE: Pancreatic cancer (PC) is the fourth leading cause of cancer death worldwide, symptoms are few and diffuse, and when the diagnosis has been made only 10-15% would benefit from resection. Surgery is the only potentially curable treatment for pancreatic cancer, and the prognosis seems to improve with early detection. A hereditary component has been identified in 1-10% of the PC cases. To comply with this, screening for PC in high-risk groups with a genetic disposition for PC has been recommended in research settings.DESIGN: Between January 2006 and February 2014 31 patients with Hereditary pancreatitis or with a disposition of HP and 40 first-degree relatives of patients with Familial Pancreatic Cancer (FPC) were screened for development of Pancreatic Ductal Adenocarcinoma (PDAC) with yearly endoscopic ultrasound. The cost-effectiveness of screening in comparison with no-screening was assessed by the incremental cost-utility ratio (ICER).RESULTS: By screening the FPC group we identified 2 patients with PDAC who were treated by total pancreatectomy. One patient is still alive, while the other died after 7 months due to cardiac surgery complications. Stratified analysis of patients with HP and FPC provided ICERs of 47,156 US$ vs. 35,493 US$ per life-year and 58,647 US$ vs. 47,867 US$ per QALY. Including only PDAC related death changed the ICER to 31,722 US$ per life-year and 42,128 US$ per QALY. The ICER for patients with FPC was estimated at 28,834 US$ per life-year and 38,785 US$ per QALY.CONCLUSIONS: With a threshold value of 50,000 US$ per QALY this screening program appears to constitute a cost-effective intervention although screening of HP patients appears to be less cost-effective than FPC patients.

AB - OBJECTIVE: Pancreatic cancer (PC) is the fourth leading cause of cancer death worldwide, symptoms are few and diffuse, and when the diagnosis has been made only 10-15% would benefit from resection. Surgery is the only potentially curable treatment for pancreatic cancer, and the prognosis seems to improve with early detection. A hereditary component has been identified in 1-10% of the PC cases. To comply with this, screening for PC in high-risk groups with a genetic disposition for PC has been recommended in research settings.DESIGN: Between January 2006 and February 2014 31 patients with Hereditary pancreatitis or with a disposition of HP and 40 first-degree relatives of patients with Familial Pancreatic Cancer (FPC) were screened for development of Pancreatic Ductal Adenocarcinoma (PDAC) with yearly endoscopic ultrasound. The cost-effectiveness of screening in comparison with no-screening was assessed by the incremental cost-utility ratio (ICER).RESULTS: By screening the FPC group we identified 2 patients with PDAC who were treated by total pancreatectomy. One patient is still alive, while the other died after 7 months due to cardiac surgery complications. Stratified analysis of patients with HP and FPC provided ICERs of 47,156 US$ vs. 35,493 US$ per life-year and 58,647 US$ vs. 47,867 US$ per QALY. Including only PDAC related death changed the ICER to 31,722 US$ per life-year and 42,128 US$ per QALY. The ICER for patients with FPC was estimated at 28,834 US$ per life-year and 38,785 US$ per QALY.CONCLUSIONS: With a threshold value of 50,000 US$ per QALY this screening program appears to constitute a cost-effective intervention although screening of HP patients appears to be less cost-effective than FPC patients.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cost-Benefit Analysis

KW - Denmark

KW - Early Detection of Cancer

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Mass Screening

KW - Middle Aged

KW - Pancreatic Neoplasms

KW - Prognosis

KW - Risk Assessment

KW - Risk Factors

KW - Smoking

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1016/j.pan.2016.03.013

DO - 10.1016/j.pan.2016.03.013

M3 - Journal article

C2 - 27090585

SN - 1424-3903

VL - 16

SP - 584

EP - 592

JO - Pancreatology

JF - Pancreatology

IS - 4

ER -