title: Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature.
abstract: Pancreatic cancer (PC) has a poor prognosis, with a 5-year survival of 3-4%. This is mainly due to late diagnosis because of diffuse symptoms, where 80-85% of the patients are inoperable. Consequently, early diagnosis would be of significant benefit, resulting in a potential 5-year survival of 30-40%. However, new technologies must be carefully evaluated concerning effectiveness and healthcare costs. We have developed a framework for modelling cost and health effects from early detection of PC, which for the first time allowed us to analyse its cost-effectiveness. A probabilistic cohort model for estimating costs and quality adjusted life-years (QALY) arising from screening for PC, compared to a "wait-and-see"-approach, was designed. The test accuracy, Swedish survival and costs by tumour stage, expected life gain from early detection and pretest probabilities in risk groups, were retrieved from previous investigations. In a cohort of newly diagnosed diabetic patient (incidence 0.71%) the incremental cost per QALY gained (ICER) was €13,500, which is considered cost-effective in Europe. Results were mainly sensitive to the incidence with the ICER ranging from €315 to €204,000 (familial PC 35% and general population 0.046%, respectively). This is the first study focusing on clinical implementation of advanced testing and what is required for novel technologies in cancer care to be cost-effective. The model clearly demonstrated the potential of multiplexed proteomic-testing of PC and also identified the requirements for test accuracy. Consequently, it can serve as a model for assessing the possibilities to introduce advanced test platforms also for other cancer indications.
authors: Swedish Institute for Health Economics, Lund, Sweden.
authors: Ola
authors: O
authors: Ghatnekar
authors: Roland
authors: R
authors: Andersson
authors: Marianne
authors: M
authors: Svensson
authors: Ulf
authors: U
authors: Persson
authors: Ulrika
authors: U
authors: Ringdahl
authors: Paula
authors: P
authors: Zeilon
authors: Carl A K
authors: CA
authors: Borrebaeck
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000191:economics* / Q000378:metabolism; D003362:Cost-Benefit Analysis / Q000191:economics; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D018803:Models, Economic; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000378:metabolism; D040901:Proteomics / Q000191:economics
chemical_list: D014408:Biomarkers, Tumor
keywords: cost utility; early diagnosis; health economics; pancreatic cancer; proteomics