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Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument. HPB (Oxford) 2015 Feb;17(2):131-9

Date

08/16/2014

Pubmed ID

25123702

Pubmed Central ID

PMC4299387

DOI

10.1111/hpb.12325

Scopus ID

2-s2.0-84920841239   13 Citations

Abstract

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 KK

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Associate 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
Susan Tsai MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Cost of Illness
Cost-Benefit Analysis
Decision Trees
Humans
Laparoscopy
Neoadjuvant Therapy
Pancreatic Neoplasms
Quality-Adjusted Life Years
United States