title: A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Harewood
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiersema
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000191:economics*; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D012680:Sensitivity and Specificity; D014463:Ultrasonography