Document Detail

Consensus guidelines in the management of branch duct intraductal papillary mucinous neoplasm: a cost-effectiveness analysis.
MedLine Citation:
PMID:  19834805     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIMS: Based on consensus guidelines, surgical resection of branch duct intraductal papillary mucinous neoplasm (BD-IPMN) is indicated in patients with symptoms of cyst size >or=30 mm, intramural nodules, or dilated main pancreatic duct greater than 6 mm. The aim of this study was to determine the cost effectiveness of consensus guideline implementation in the management of BD-IPMN.
METHODS: We developed a decision analytic model to compare the costs and effectiveness of three management strategies for a cohort of 60-year-old patients with branch duct IPMN: (1) surveillance using consensus guidelines for surgical resection (surveillance strategy), (2) surgical resection based on symptoms without surveillance (no surveillance strategy), and (3) immediate surgery (surgery strategy). The primary outcomes were quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratio (ICER). Sensitivity analysis was performed over a wide ranges of estimates.
RESULTS: The no surveillance strategy was the least costly, but also the least effective, while the surgery strategy was the most costly and most effective. Compared to the no surveillance strategy, the surveillance strategy cost an additional $20,096 per QALY. The incremental cost-effectiveness ratio of the surgery strategy compared with the surveillance strategy was $132,436 per QALY. In a probabilistic sensitivity analysis, if society was willing to pay $50,000 per quality-adjusted life year gained, then 88.1% of patients using the surveillance strategy would be within budget.
CONCLUSIONS: Immediate surgery is the most effective, but may be prohibitively expensive. The surveillance strategy is a cost-effective option compared to no surveillance.
Edward S Huang; G Scott Gazelle; Chin Hur
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-10-16
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  55     ISSN:  1573-2568     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-17     Completed Date:  2010-03-11     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  852-60     Citation Subset:  AIM; IM    
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MeSH Terms
Adenocarcinoma, Mucinous / surgery*
Carcinoma, Intraductal, Noninfiltrating / surgery*
Carcinoma, Papillary / surgery*
Cost-Benefit Analysis
Decision Support Techniques
Middle Aged
Pancreatic Neoplasms / surgery*
Practice Guidelines as Topic
Quality of Life
Sensitivity and Specificity
United States
Grant Support
K07 CA107060/CA/NCI NIH HHS; K07 CA107060-05/CA/NCI NIH HHS; K07CA107060/CA/NCI NIH HHS; T32 DK007191-35/DK/NIDDK NIH HHS; T32DK007191/DK/NIDDK NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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