Potential Cost-Effectiveness of Risk-Based Pancreatic Cancer Screening in Patients With New-Onset Diabetes

Area of Science:

• Oncology
• Medical Economics
• Radiology

Background:

• Pancreatic cancer (PAC) lacks established screening methods, but new-onset diabetes (NOD) patients are at elevated risk.
• National Cancer Institute (NCI) and Pancreatic Cancer Action Network (PanCAN) are exploring risk-based screening strategies for PAC in NOD patients.
• Preliminary cost-effectiveness analysis can guide future data collection and trial design for PAC screening.

Purpose of the Study:

• To assess the cost-effectiveness of CT screening for PAC in patients aged ≥50 years with NOD.
• To evaluate the potential value of risk-based PAC screening strategies.

Main Methods:

• An integrated decision tree and Markov model were used to compare CT screening versus no screening.
• Data on PAC prevalence, sensitivity, specificity, and survival were sourced from the END-PAC study and SEER program.
• Life-years (LYs), quality-adjusted LYs (QALYs), and costs were analyzed over a lifetime horizon with 3% discount rate.

Main Results:

• Base case: screening yielded 0.0045 QALYs and $293 additional cost per patient, with a cost per QALY gained of $65,076.
• Probabilistic analysis: cost per QALY gained was <$50,000 in 34% and <$100,000 in 99% of simulations.
• Threshold analysis: over 25% of screen-detected PAC cases must be resectable for screening to be cost-effective (<$100,000 per QALY gained).

Conclusions:

• Risk-based PAC screening in NOD patients is likely cost-effective in the US if a modest fraction (>25%) of screen-detected PAC cases are resectable.
• Further evaluation is recommended once clinical trial data from initiatives like the PanCAN Early Detection Initiative become available.