title: Is screening for pancreatic cancer in high-risk groups cost-effective? - Experience from a Danish national screening program.
abstract: OBJECTIVE
  Pancreatic cancer (PC) is the fourth leading cause of cancer death worldwide, symptoms are few and diffuse, and when the diagnosis has been made only 10-15% would benefit from resection. Surgery is the only potentially curable treatment for pancreatic cancer, and the prognosis seems to improve with early detection. A hereditary component has been identified in 1-10% of the PC cases. To comply with this, screening for PC in high-risk groups with a genetic disposition for PC has been recommended in research settings.
  
  
  METHODS
  Between January 2006 and February 2014 31 patients with Hereditary pancreatitis or with a disposition of HP and 40 first-degree relatives of patients with Familial Pancreatic Cancer (FPC) were screened for development of Pancreatic Ductal Adenocarcinoma (PDAC) with yearly endoscopic ultrasound. The cost-effectiveness of screening in comparison with no-screening was assessed by the incremental cost-utility ratio (ICER).
  
  
  RESULTS
  By screening the FPC group we identified 2 patients with PDAC who were treated by total pancreatectomy. One patient is still alive, while the other died after 7 months due to cardiac surgery complications. Stratified analysis of patients with HP and FPC provided ICERs of 47,156 US$ vs. 35,493 US$ per life-year and 58,647 US$ vs. 47,867 US$ per QALY. Including only PDAC related death changed the ICER to 31,722 US$ per life-year and 42,128 US$ per QALY. The ICER for patients with FPC was estimated at 28,834 US$ per life-year and 38,785 US$ per QALY.
  
  
  CONCLUSIONS
  With a threshold value of 50,000 US$ per QALY this screening program appears to constitute a cost-effective intervention although screening of HP patients appears to be less cost-effective than FPC patients.
authors.affiliation: Vejle Hospital, Southern Denmark, Odense, Denmark; Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark. Electronic address: maiken.t.joergensen@rsyd.dk.
authors.forename: Maiken Thyregod
authors.initials: MT
authors.lastname: Joergensen
authors.affiliation: Juliane Marie Centret, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Gerdes
authors.affiliation: Centre for Health Economic Research (COHERE), Institute of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Sorensen
authors.affiliation: Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark.
authors.forename: Ove
authors.initials: O
authors.lastname: Schaffalitzky de Muckadell
authors.affiliation: Department of Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Michael Bau
authors.initials: MB
authors.lastname: Mortensen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003718:Denmark; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Cost-utility analysis (CUA); Familial pancreatic cancer (FPC); Hereditary pancreatitis (HP); Incremental cost-effectiveness ratios (ICER); Quality-adjusted life-years (QALY); Screening