Consensus guidelines in the management of branch duct intraductal papillary mucinous neoplasm: a cost-effectiveness analysis.
OBJECTIVE
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.
Huang
Edward S
ES
Gastrointestinal Unit, Massachusetts General Hospital, 10th Floor, Boston, MA 02114, USA. eshuang@partners.org
Gazelle
G Scott
GS
Hur
Chin
C
D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000328:Adult; D000368:Aged; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012680:Sensitivity and Specificity; D014481:United States