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

Maiken Thyregod Jøergensen; Anne-Marie Gerdes; Jan Sørensen; Ove Schaffalitzky de Muckadell; Michael Bau Mortensen

doi:10.1016/j.pan.2016.03.013

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

Maiken Thyregod Jøergensen, Anne-Marie Gerdes, Jan Sørensen, Ove Schaffalitzky de Muckadell, Michael Bau Mortensen

Department of Clinical Medicine

17 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Pancreatology
Volume	16
Issue number	4
Pages (from-to)	584-92
Number of pages	9
ISSN	1424-3903
DOIs	https://doi.org/10.1016/j.pan.2016.03.013
Publication status	Published - 1 Jul 2016

Keywords

Adult
Aged
Aged, 80 and over
Cost-Benefit Analysis
Denmark
Early Detection of Cancer
Female
Humans
Incidence
Male
Mass Screening
Middle Aged
Pancreatic Neoplasms
Prognosis
Risk Assessment
Risk Factors
Smoking
Treatment Outcome
Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.pan.2016.03.013

Cite this

@article{20a317c76f934afcba0888b0b3071a60,

title = "Is screening for pancreatic cancer in high-risk groups cost-effective?: Experience from a Danish national screening program",

abstract = "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.",

keywords = "Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Denmark, Early Detection of Cancer, Female, Humans, Incidence, Male, Mass Screening, Middle Aged, Pancreatic Neoplasms, Prognosis, Risk Assessment, Risk Factors, Smoking, Treatment Outcome, Journal Article",

author = "J{\o}ergensen, {Maiken Thyregod} and Anne-Marie Gerdes and Jan S{\o}rensen and {Schaffalitzky de Muckadell}, Ove and Mortensen, {Michael Bau}",

year = "2016",

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doi = "10.1016/j.pan.2016.03.013",

language = "English",

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pages = "584--92",

journal = "Pancreatology",

issn = "1424-3903",

publisher = "Elsevier",

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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

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