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Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis.

Publication ,  Journal Article
Tzeng, C-WD; Abbott, DE; Cantor, SB; Fleming, JB; Lee, JE; Pisters, PWT; Varadhachary, GR; Abbruzzese, JL; Wolff, RA; Ahmad, SA; Katz, MHG
Published in: Ann Surg Oncol
July 2013

BACKGROUND: Few data exist to guide oncologic surveillance following curative treatment of pancreatic cancer. We sought to identify a rational, cost-effective postoperative surveillance strategy. METHODS: We constructed a Markov model to compare the cost-effectiveness of 5 postoperative surveillance strategies. No scheduled surveillance served as the baseline strategy. Clinical evaluation and carbohydrate antigen (CA) 19-9 testing without/with routine computed tomography and chest X-ray at either 6- or 3-month intervals served as the 4 comparison strategies of increasing intensity. We populated the model with symptom, recurrence, treatment, and survival data from patients who had received intensive surveillance after multimodality treatment at our institution between 1998 and 2008. Costs were based on Medicare payments (2011 US dollars). RESULTS: The baseline strategy of no scheduled surveillance was associated with a postoperative overall survival (OS) of 24.6 months and a cost of $3837/patient. Clinical evaluation and CA 19-9 assay every 6 months until recurrence was associated with a 32.8-month OS and a cost of $7496/patient, with an incremental cost-effectiveness ratio (ICER) of $5364/life-year (LY). Additional routine imaging every 6 months incrementally increased total cost by $3465 without increasing OS. ICERs associated with clinic visits every 3 months without/with routine imaging were $127,680 and $294,696/LY, respectively. Sensitivity analyses changed the strategies' absolute costs but not the relative ranks of their ICERs. CONCLUSIONS: Increasing the frequency and intensity of postoperative surveillance of patients after curative therapy for pancreatic cancer beyond clinical evaluation and CA 19-9 testing every 6 months increases cost but confers no clinically significant survival benefit.

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Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2013

Volume

20

Issue

7

Start / End Page

2197 / 2203

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Radiography, Thoracic
  • Population Surveillance
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Office Visits
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
 

Citation

APA
Chicago
ICMJE
MLA
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Tzeng, C.-W., Abbott, D. E., Cantor, S. B., Fleming, J. B., Lee, J. E., Pisters, P. W. T., … Katz, M. H. G. (2013). Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis. Ann Surg Oncol, 20(7), 2197–2203. https://doi.org/10.1245/s10434-013-2889-6
Tzeng, Ching-Wei D., Daniel E. Abbott, Scott B. Cantor, Jason B. Fleming, Jeffrey E. Lee, Peter W. T. Pisters, Gauri R. Varadhachary, et al. “Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis.Ann Surg Oncol 20, no. 7 (July 2013): 2197–2203. https://doi.org/10.1245/s10434-013-2889-6.
Tzeng C-WD, Abbott DE, Cantor SB, Fleming JB, Lee JE, Pisters PWT, et al. Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis. Ann Surg Oncol. 2013 Jul;20(7):2197–203.
Tzeng, Ching-Wei D., et al. “Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis.Ann Surg Oncol, vol. 20, no. 7, July 2013, pp. 2197–203. Pubmed, doi:10.1245/s10434-013-2889-6.
Tzeng C-WD, Abbott DE, Cantor SB, Fleming JB, Lee JE, Pisters PWT, Varadhachary GR, Abbruzzese JL, Wolff RA, Ahmad SA, Katz MHG. Frequency and intensity of postoperative surveillance after curative treatment of pancreatic cancer: a cost-effectiveness analysis. Ann Surg Oncol. 2013 Jul;20(7):2197–2203.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

July 2013

Volume

20

Issue

7

Start / End Page

2197 / 2203

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Time Factors
  • Radiography, Thoracic
  • Population Surveillance
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Office Visits
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy