A systematic review of economic evaluation in pancreatic cystic neoplasms.

BACKGROUND

High-resolution imaging techniques are recommended for screening and surveillance of pancreatic cystic neoplasms (PCNs). This study aimed to systematically review current evidence on the economic aspects of PCN management.

METHODS

Original studies published up to November 2023 were identified from PubMed, Embase, and Cochrane databases. Included studies conducted economic evaluations or modeled the natural history of pancreatic diseases. Data on costs, effectiveness, and model parameters were extracted.

RESULTS

A total of 33 studies were eligible for this review. Of 26 model-based studies, only three included histopathological features of pancreatic ductal adenocarcinoma (PDAC), and five incorporated different cancer stages. Compared to no screening or surveillance, the IAP 2006 guideline was cost-effective ($26,158/QALY), whereas IAP 2017 was not ($180,395/QALY). Using imaging modalities (computed tomography, magnetic resonance imaging, and endoscopic ultrasound) was more cost-effective than the full-watching strategy in populations of high-risk pancreatic cancer (e.g., 3-year PDAC risk of at least 1 %, familial or hereditary diseases, or new onset diabetes). In contrast, immediate resection-based strategies were not cost-effective at the level of willingness-to-pay of $100,000.

CONCLUSION

Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.