Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument. HPB (Oxford) 2015 Feb;17(2):131-9
Date
08/16/2014Pubmed ID
25123702Pubmed Central ID
PMC4299387DOI
10.1111/hpb.12325Scopus ID
2-s2.0-84920841239 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
OBJECTIVES: Laparoscopy is recommended to detect radiographically occult metastases in patients with pancreatic cancer before curative resection. This study was conducted to test the hypothesis that diagnostic laparoscopy (DL) is cost-effective in patients undergoing curative resection with or without neoadjuvant therapy (NAT).
METHODS: Decision tree modelling compared routine DL with exploratory laparotomy (ExLap) at the time of curative resection in resectable cancer treated with surgery first, (SF) and borderline resectable cancer treated with NAT. Costs (US$) from the payer's perspective, quality-adjusted life months (QALMs) and incremental cost-effectiveness ratios (ICERs) were calculated. Base case estimates and multi-way sensitivity analyses were performed. Willingness to pay (WtP) was US$4166/QALM (or US$50,000/quality-adjusted life year).
RESULTS: Base case costs were US$34,921 for ExLap and US$33,442 for DL in SF patients, and US$39,633 for ExLap and US$39,713 for DL in NAT patients. Routine DL is the dominant (preferred) strategy in both treatment types: it allows for cost reductions of US$10,695/QALM in SF and US$4158/QALM in NAT patients.
CONCLUSIONS: The present analysis supports the cost-effectiveness of routine DL before curative resection in pancreatic cancer patients treated with either SF or NAT.
Author List
Jayakrishnan TT, Nadeem H, Groeschl RT, George B, Thomas JP, Ritch PS, Christians KK, Tsai S, Evans DB, Pappas SG, Gamblin TC, Turaga KKAuthors
Kathleen K. Christians MD Professor in the Surgery department at Medical College of WisconsinDouglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Professor in the Medicine department at Medical College of Wisconsin
James P. Thomas MD, PhD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Cost of IllnessCost-Benefit Analysis
Decision Trees
Humans
Laparoscopy
Neoadjuvant Therapy
Pancreatic Neoplasms
Quality-Adjusted Life Years
United States