Harewood G C, Wiersema M J
Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2001 Sep;96(9):2651-6. doi: 10.1111/j.1572-0241.2001.04116.x.
Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) biopsy of nonperitumoral (NPT) lymph nodes (LN) can be helpful in preoperative staging of pancreatic head adenocarcinoma. The economic impact of this staging strategy has not yet been described. The aim of this study was to apply a decision analysis model to compare the costs of three approaches to the management of nonmetastatic pancreatic head adenocarcinoma: EUS FNA versus CT-guided FNA versus surgery. A cost minimization approach was employed, as viewed from the perspective of the payer.
A decision analysis model was designed using DATA Version 3.5, taking the entry criteria as "resectable" pancreatic head adenocarcinoma as determined by helical CT. Detection of metastatic NPT LN on FNA signified unresectability and obviated the need for surgery. Baseline probabilities were varied through plausible ranges using sensitivity analysis. Cost inputs were based on Medicare professional plus facility fees. The endpoint was cost of management per patient.
EUS FNA was the least costly strategy ($15,938) compared with CT FNA ($16,378) and surgery ($18,723). Sensitivity analysis revealed that EUS FNA remained the least costly option provided the frequency of NPT LN involvement was >4%; below this value, surgery became the least costly.
EUS FNA is the least costly staging strategy in the workup of patients with nonmetastatic pancreatic head adenocarcinoma primarily because of confirmation of NPT LN involvement avoiding unnecessary surgery. These results support performing EUS in patients whose tumors are thought to be resectable on helical CT to enhance NPT LN assessment.
内镜超声（EUS）引导下对胰腺周围非肿瘤（NPT）区域淋巴结（LN）进行细针穿刺抽吸（FNA）活检，有助于胰头腺癌的术前分期。这种分期策略的经济影响尚未见报道。本研究旨在应用决策分析模型，比较三种非转移性胰头腺癌治疗方法的成本：EUS-FNA与CT引导下FNA以及手术治疗。从支付方的角度出发，采用成本最小化方法。
使用DATA Version 3.5设计决策分析模型，将螺旋CT确定的“可切除”胰头腺癌作为纳入标准。FNA检查发现转移性NPT区域LN意味着不可切除，无需进行手术。通过敏感性分析，在合理范围内改变基线概率。成本投入基于医疗保险专业费用加机构费用。终点指标是每位患者的治疗成本。
与CT-FNA（16378美元）和手术治疗（18723美元）相比，EUS-FNA是成本最低的策略（15938美元）。敏感性分析显示，只要NPT区域LN受累频率>4%，EUS-FNA仍然是成本最低的选择；低于该值时，手术治疗成本最低。
EUS-FNA是对非转移性胰头腺癌患者进行检查时成本最低的分期策略，主要是因为确认NPT区域LN受累可避免不必要的手术。这些结果支持对螺旋CT显示肿瘤可切除的患者进行EUS检查，以加强对NPT区域LN的评估。
