Cost-effectiveness of pancreatic cancer screening in familial pancreatic cancer kindreds

Background: Endoscopic screening of families predisposed to pancreatic cancer is increasingly used, but the cost-effectiveness of screening is unknown. Methods: A decision analysis was used to compare one-time screening for pancreatic dysplasia with EUS to no screening in a hypothetical cohort of 100 members of familial pancreatic cancer kindreds. Abnormal EUS findings are confirmed with ERCP and patients with abnormal findings are candidates for total pancreatectomy. Lifetime medical care costs and life expectancy were modeled, and the main analysis was conducted from the third-party payer perspective. The base-case analysis assumed a 20% prevalence of pancreatic dysplasia and 90% sensitivity of EUS and ERCP. Results: Endoscopic screening was cost-effective, with an incremental cost-effectiveness ratio of $16,885/life-year saved. Screening was more cost-effective as the probability of dysplasia increased and as the sensitivity of EUS and ERCP increased. Screening remained cost-effective if the prevalence of dysplasia was greater than 16% or if the sensitivity of EUS was greater than 84%. Procedure costs had a limited impact on cost-effectiveness. Conclusions: Endoscopic screening of carefully selected members of familial pancreatic cancer kindreds appears to increase patient life expectancy in a cost-effective manner. Screening should be performed in centers that have experience with endoscopic screening for pancreatic dysplasia. The cost-effectiveness of repeated screening remains to be determined. (Gastrointest Endosc 2003;57:23-9.)