Additional MRI for initial M-staging in pancreatic cancer: a cost-effectiveness analysis

Abstract

Objective Pancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer. Methods A decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters. Conclusion Based on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer. Key Points • Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness. • The economic model showed high robustness for varying input parameters.

Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics

“…MRI provides relevant information for the diagnostic evaluation of malignant pancreatic tumors [382,383] by predicting the survival in advanced pancreatic cancer patients [384]. The use of MRI of the liver for the initial staging of pancreatic cancer results in lower total costs and higher effectiveness [385]. MRI and CT show similar performance in the presurgical evaluation of pancreatic cancer [386,387].…”

Impact of a Targeted Project for Shortening of Imaging Diagnostic Waiting Time in Patients with Suspected Oncological Diseases in Hungary

“…A marker that can be used to assess the overall success of the diagnostic methods for any oncological disease (whose progression is well known) is the length of diagnostic workup measured in days (time to diagnosis), as this has a significant impact on the patient’s therapeutic options, i.e., the chance of survival [ 3 ]. Several studies have confirmed that the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) as early diagnostic tools is not only cost-effective, but also increases quality-adjusted life years (QALYs) and potentially increases survival rates [ 4 , 5 , 6 , 7 , 8 ]. Therefore, the time spent on diagnostic imaging investigations and the total diagnostic interval, from the first suspicion or detection of the disease to the initiation of oncological therapy, are considered as important indicators.…”