Department of Radiology, G.B. Rossi Hospital, Università di Verona, Piazzale L.A.Scuro 10, 37134, Verona, Italy.
IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
Radiol Med. 2022 Apr;127(4):349-359. doi: 10.1007/s11547-022-01459-8. Epub 2022 Mar 1.
Pancreatic cystic neoplasms (PCN) management consists of non-invasive imaging studies (CT, MRI), with a high resource burden. We aimed to determine the cost-effectiveness of including contrast-enhanced ultrasound (CEUS) in the management of PCN without risk features.
By using a decision-tree model in a hypothetical cohort of patients, we compared management strategy including CEUS with the latest Fukuoka consensus, European and Italian guidelines. Our strategy for BD-IPMN/MCN < 1 cm includes 1 CEUS annually. For those between 1 and 2 cm, it includes CEUS 4 times/year during the first year, then 3 times/year for 4 years and then annually. For those between 2 and 3 cm, it comprises MRI twice/year during the first one, then alternating 2 CEUS and 1 MRI yearly.
CEUS surveillance is the dominant strategy in all scenarios. CEUS surveillance average cost is 1,984.72 €, mean QALY 11.79 and mean ICER 181.99 €. If willingness to pay is 30,000 €, 45% of patients undergone CEUS surveillance of BDIPMN/MCN < 1 cm would be within budget.
Guidelines strategies are very effective, but costs are relatively high from a policy perspective. CEUS surveillance may be a cost-effective strategy yielding a nearly high QALYs, an acceptable ICER, and a lower cost.
胰腺囊性肿瘤（PCN）的管理包括非侵入性成像研究（CT、MRI），但资源负担较高。我们旨在确定在没有风险特征的情况下将对比增强超声（CEUS）纳入 PCN 管理的成本效益。
通过在假设的患者队列中使用决策树模型，我们将包括 CEUS 的管理策略与最新的福冈共识、欧洲和意大利指南进行了比较。我们对 BD-IPMN/MCN <1cm 的策略包括每年进行 1 次 CEUS。对于 1 到 2cm 之间的患者，第一年包括 4 次 CEUS，然后在接下来的 4 年内每年 3 次，然后每年 1 次。对于 2 到 3cm 之间的患者，第一年包括每年 2 次 MRI，然后每年交替进行 2 次 CEUS 和 1 次 MRI。
CEUS 监测是所有情况下的主导策略。CEUS 监测的平均成本为 1984.72 欧元，平均 QALY 为 11.79，平均 ICER 为 181.99 欧元。如果支付意愿为 30,000 欧元，则 45%接受 CEUS 监测的 BDIPMN/MCN <1cm 的患者将在预算范围内。
指南策略非常有效，但从政策角度来看，成本相对较高。CEUS 监测可能是一种具有成本效益的策略，可获得较高的 QALYs、可接受的 ICER 和较低的成本。
