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Cost-effectiveness of consensus guideline based management of pancreatic cysts: The sensitivity and specificity required for guidelines to be cost-effective.

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Sharib, J; Esserman, L; Koay, EJ; Maitra, A; Shen, Y; Kirkwood, KS; Ozanne, EM
Published in: Surgery
October 2020

Detection of cystic lesions of the pancreas has outpaced our ability to stratify low-grade cystic lesions from those at greater risk for pancreatic cancer, raising a concern for overtreatment.We developed a Markov decision model to determine the cost-effectiveness of guideline-based management for asymptomatic pancreatic cysts. Incremental costs per quality-adjusted life year gained and survival were calculated for current management guidelines. A sensitivity analysis estimated the effect on cost-effectiveness and mortality if overtreatment of low-grade cysts is avoided, and the sensitivity and specificity thresholds required of methods of cyst stratification to improve costs expended."Surveillance" using current management guidelines had an incremental cost-effectiveness ratio of $171,143/quality adjusted life year compared with no surveillance or operative treatment ("do nothing"). An incremental cost-effectiveness ratio for surveillance decreases to $80,707/quality adjusted life year if the operative overtreatment of low-grade cysts was avoided. Assuming a societal willingness-to-pay of $100,000/quality adjusted life year, the diagnostic specificity for high-risk cysts must be >67% for surveillance to be preferred over surgery and "do nothing." Changes in sensitivity alone cannot make surveillance cost-effective. Most importantly, survival in surveillance is worse than "do nothing" for 3 years after cyst diagnosis, although long-term survival is improved. The disadvantage is eliminated when overtreatment of low-grade cysts is avoided.Current management of pancreatic cystic lesions is not cost-effective and may increase mortality owing to overtreatment of low-grade cysts. The specificity for risk stratification for high-risk cysts must be greater than 67% to make surveillance cost-effective.

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Published In

Surgery

DOI

EISSN

1532-7361

ISSN

0039-6060

Publication Date

October 2020

Volume

168

Issue

4

Start / End Page

601 / 609

Related Subject Headings

  • Unnecessary Procedures
  • Survival Analysis
  • Surgery
  • Sensitivity and Specificity
  • Risk Assessment
  • Quality-Adjusted Life Years
  • Practice Guidelines as Topic
  • Pancreatic Cyst
  • Middle Aged
  • Markov Chains
 

Citation

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Sharib, J., Esserman, L., Koay, E. J., Maitra, A., Shen, Y., Kirkwood, K. S., & Ozanne, E. M. (2020). Cost-effectiveness of consensus guideline based management of pancreatic cysts: The sensitivity and specificity required for guidelines to be cost-effective. In Surgery (Vol. 168, pp. 601–609). https://doi.org/10.1016/j.surg.2020.04.052
Sharib, Jeremy, Laura Esserman, Eugene J. Koay, Anirban Maitra, Yu Shen, Kimberly S. Kirkwood, and Elissa M. Ozanne. “Cost-effectiveness of consensus guideline based management of pancreatic cysts: The sensitivity and specificity required for guidelines to be cost-effective.” In Surgery, 168:601–9, 2020. https://doi.org/10.1016/j.surg.2020.04.052.
Sharib, Jeremy, et al. “Cost-effectiveness of consensus guideline based management of pancreatic cysts: The sensitivity and specificity required for guidelines to be cost-effective.Surgery, vol. 168, no. 4, 2020, pp. 601–09. Epmc, doi:10.1016/j.surg.2020.04.052.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

ISSN

0039-6060

Publication Date

October 2020

Volume

168

Issue

4

Start / End Page

601 / 609

Related Subject Headings

  • Unnecessary Procedures
  • Survival Analysis
  • Surgery
  • Sensitivity and Specificity
  • Risk Assessment
  • Quality-Adjusted Life Years
  • Practice Guidelines as Topic
  • Pancreatic Cyst
  • Middle Aged
  • Markov Chains