Cost-effectiveness of a Risk-Tailored Pancreatic Cancer Early Detection Strategy among Patients with New-Onset Diabetes.

Abstract Background & Aims Screening for pancreatic ductal adenocarcinoma (PDAC) in asymptomatic adults is not recommended, but patients with new-onset diabetes (NoD) have an eight times higher risk of PDAC than expected. A novel risk-tailored early detection strategy targeting high-risk NoD patients might improve PDAC prognosis. We sought to evaluate the cost-effectiveness of this strategy. Methods We compared PDAC early detection strategies targeting NoD individuals ≥ 50 years old at various minimal predicted PDAC risk thresholds vs. standard of care in a Markov state-transition decision model under the healthcare sector perspective using a lifetime horizon. Results At a willingness to pay (WTP) of $150,000/QALY, the early detection strategy targeting those with a minimum predicted 3-year PDAC risk of 1% was cost-effective (Incremental Cost-effectiveness Ratio [ICER] $116,911). At a WTP of $100,000/QALY, the early detection strategy at the 2% risk threshold was cost-effective (ICER $63,045). The proportion of PDACs detected at local stage, costs of treatment for metastatic PDAC, utilities of local and regional cancers, and sensitivity of screening were the most influential parameters. Probabilistic sensitivity analysis confirmed that at a WTP of $150,000, early detection at the 1.0% risk threshold was favored (30.6%), followed by the 0.5% risk threshold (20.4%) vs. standard of care (1.7%). At a WTP of $100,000, early detection at the 1.0% risk threshold was favored (27.3%) followed by the 2.0% risk threshold (22.8%) vs. standard of care (2.0%). Conclusions A risk-tailored PDAC early detection strategy targeting NoD patients with minimum predicted 3-year PDAC risk of 1.0-2.0% may be cost-effective.