Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

作者：Jayakrishnan Thejus T; Nadeem Hasan; Groeschl Ryan T; George Ben; Thomas James P; Ritch Paul S; Christians Kathleen K; Tsai Susan; Evans Douglas B; Pappas Sam G; Gamblin T Clark; Turaga Kiran K^*

来源：Hepato Pancreato Biliary, 2015, 17(2): 131-139.

DOI：10.1111/hpb.12325

ObjectivesLaparoscopy is recommended to detect radiographically occult metastases in patients with pancreatic cancer before curative resection. This study was conducted to test the hypothesis that diagnostic laparoscopy (DL) is cost-effective in patients undergoing curative resection with or without neoadjuvant therapy (NAT).
MethodsDecision tree modelling compared routine DL with exploratory laparotomy (ExLap) at the time of curative resection in resectable cancer treated with surgery first, (SF) and borderline resectable cancer treated with NAT. Costs (US$) from the payer's perspective, quality-adjusted life months (QALMs) and incremental cost-effectiveness ratios (ICERs) were calculated. Base case estimates and multi-way sensitivity analyses were performed. Willingness to pay (WtP) was US$4166/QALM (or US$50000/quality-adjusted life year).
ResultsBase case costs were US$34921 for ExLap and US$33442 for DL in SF patients, and US$39633 for ExLap and US$39713 for DL in NAT patients. Routine DL is the dominant (preferred) strategy in both treatment types: it allows for cost reductions of US$10695/QALM in SF and US$4158/QALM in NAT patients.
ConclusionsThe present analysis supports the cost-effectiveness of routine DL before curative resection in pancreatic cancer patients treated with either SF or NAT.

• 出版日期2015-2