From the Department of Occupational Health, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan.
Pancreas. 2020 Sep;49(8):1052-1056. doi: 10.1097/MPA.0000000000001614.
The aim of the study was to assess cost-effectiveness of abdominal ultrasound, magnetic resonance imaging, endoscopic ultrasound, computed tomography, positron emission tomography, and no screening for pancreatic cancer screening in familial high-risk individuals (HRIs).
We developed decision trees with Markov models for a hypothetical cohort of familial HRIs at the age of 50 year using a healthcare sector perspective and a lifetime horizon. Main outcomes were costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
In a base-case analysis, abdominal ultrasound was the most cost-effective (US $11,035, 17.4875 QALYs). Magnetic resonance imaging yielded the best benefits. Cost-effectiveness was sensitive to the incidence of pancreatic cancer. Endoscopic ultrasound was more cost-effective than abdominal ultrasound when the incidence of pancreatic cancer was greater than 0.008 and under 0.016. Magnetic resonance imaging was more cost-effective than endoscopic ultrasound when the incidence of pancreatic cancer was greater than 0.016. Probabilistic sensitivity analysis using Monte-Carlo simulation for 10,000 trials demonstrated that abdominal ultrasound was cost-effective 76% of the time at a willingness-to-pay threshold of US $50,000/QALY gained.
Abdominal ultrasound is the most cost-effective and recommended for pancreatic cancer screening in familial HRIs in Japan. Evaluating the risk of pancreatic cancer among familial HRIs as a target for screening is significant.
本研究旨在评估在家族性高风险个体（HRIs）中进行腹部超声、磁共振成像、内镜超声、计算机断层扫描、正电子发射断层扫描和无筛查的成本效益。
我们使用医疗保健部门的视角和终生时间范围，为假设的家族性 HRIs 队列开发了决策树和马尔可夫模型。主要结果是成本、质量调整生命年（QALYs）和增量成本效益比。
在基本分析中，腹部超声是最具成本效益的（US $11,035，17.4875 QALYs）。磁共振成像产生了最佳效益。成本效益对胰腺癌的发病率敏感。当胰腺癌的发病率大于 0.008 且小于 0.016 时，内镜超声比腹部超声更具成本效益。当胰腺癌的发病率大于 0.016 时，磁共振成像比内镜超声更具成本效益。使用蒙特卡罗模拟进行 10,000 次试验的概率敏感性分析表明，在愿意支付的 50,000 美元/QALY 获得阈值下，腹部超声在 76%的时间内具有成本效益。
腹部超声是日本家族性 HRIs 胰腺癌筛查最具成本效益的方法。评估家族性 HRIs 中胰腺癌的风险作为筛查的目标具有重要意义。
