Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Gut. 2024 May 10;73(6):955-965. doi: 10.1136/gutjnl-2023-330329.
Current guidelines recommend long-term image-based surveillance for patients with low-risk intraductal papillary mucinous neoplasms (IPMNs). This simulation study aimed to examine the comparative cost-effectiveness of continued versus discontinued surveillance at different ages and define the optimal age to stop surveillance.
We constructed a Markov model with a lifetime horizon to simulate the clinical course of patients with IPMNs receiving imaging-based surveillance. We calculated incremental cost-effectiveness ratios (ICERs) for continued versus discontinued surveillance at different ages to stop surveillance, stratified by sex and IPMN types (branch-duct vs mixed-type). We determined the optimal age to stop surveillance as the lowest age at which the ICER exceeded the willingness-to-pay threshold of US$100 000 per quality-adjusted life year. To estimate model parameters, we used a clinical cohort of 3000 patients with IPMNs and a national database including 40 166 patients with pancreatic cancer receiving pancreatectomy as well as published data.
In male patients, the optimal age to stop surveillance was 76-78 years irrespective of the IPMN types, compared with 70, 73, 81, and 84 years for female patients with branch-duct IPMNs <20 mm, =20-29 mm, ≥30 mm and mixed-type IPMNs, respectively. The suggested ages became younger according to an increasing level of comorbidities. In cases with high comorbidity burden, the ICERs were above the willingness-to-pay threshold irrespective of sex and the size of branch-duct IPMNs.
The cost-effectiveness of long-term IPMN surveillance depended on sex, IPMN types, and comorbidity levels, suggesting the potential to personalise patient management from the health economic perspective.
目前的指南建议对低危胰管内乳头状黏液性肿瘤（IPMN）患者进行长期基于影像学的监测。本模拟研究旨在探讨不同年龄继续或停止监测的比较成本效益，并确定停止监测的最佳年龄。
我们构建了一个具有终生时间范围的马尔可夫模型，以模拟接受基于影像学监测的 IPMN 患者的临床病程。我们计算了不同年龄停止监测时继续监测与停止监测的增量成本效益比（ICER），并按性别和 IPMN 类型（分支型与混合型）进行分层。我们将停止监测的最佳年龄定义为 ICER 超过美国每质量调整生命年 10 万美元意愿支付阈值的最低年龄。为了估计模型参数，我们使用了一个包含 3000 例 IPMN 患者的临床队列和一个包含 40166 例接受胰腺切除术的胰腺癌患者的国家数据库，以及已发表的数据。
在男性患者中，无论 IPMN 类型如何，停止监测的最佳年龄均为 76-78 岁，而对于分支型 IPMN <20mm、=20-29mm、≥30mm 和混合型 IPMN 的女性患者，停止监测的最佳年龄分别为 70、73、81 和 84 岁。随着合并症水平的增加，建议的年龄变得更年轻。在合并症负担较高的情况下，无论性别和分支型 IPMN 的大小如何，ICER 均高于意愿支付阈值。
长期 IPMN 监测的成本效益取决于性别、IPMN 类型和合并症水平，这表明从健康经济学的角度来看，有可能对患者管理进行个体化。
