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  • Optimal age to discontinue long-term surveillance of intraductal papillary mucinous neoplasms: comparative cost-effectiveness of surveillance by age

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Pancreas
Original research
Optimal age to discontinue long-term surveillance of intraductal papillary mucinous neoplasms: comparative cost-effectiveness of surveillance by age
  1. Tsuyoshi Hamada1,2,3,
  2. Hiroki Oyama1,
  3. Ataru Igarashi3,4,5,
  4. Yoshikuni Kawaguchi3,6,
  5. Mihye Lee3,
  6. Hiroki Matsui7,
  7. Nobuaki Michihata8,
  8. Yousuke Nakai1,9,
  9. Kiyohide Fushimi10,
  10. Hideo Yasunaga7,
  11. Mitsuhiro Fujishiro1
  1. 1 Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2 Department of Hepato-Biliary-Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
  3. 3 Graduate School of Public Health, St Luke’s International University, Tokyo, Japan
  4. 4 Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
  5. 5 Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
  6. 6 Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  7. 7 Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
  8. 8 Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  9. 9 Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan
  10. 10 Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
  1. Correspondence to Dr Tsuyoshi Hamada, Department of Gastroenterology, The University of Tokyo, Tokyo, Japan; hamada-tky{at}umin.ac.jp

Abstract

Objective Current guidelines recommend long-term image-based surveillance for patients with low-risk intraductal papillary mucinous neoplasms (IPMNs). This simulation study aimed to examine the comparative cost-effectiveness of continued versus discontinued surveillance at different ages and define the optimal age to stop surveillance.

Design We constructed a Markov model with a lifetime horizon to simulate the clinical course of patients with IPMNs receiving imaging-based surveillance. We calculated incremental cost-effectiveness ratios (ICERs) for continued versus discontinued surveillance at different ages to stop surveillance, stratified by sex and IPMN types (branch-duct vs mixed-type). We determined the optimal age to stop surveillance as the lowest age at which the ICER exceeded the willingness-to-pay threshold of US$100 000 per quality-adjusted life year. To estimate model parameters, we used a clinical cohort of 3000 patients with IPMNs and a national database including 40 166 patients with pancreatic cancer receiving pancreatectomy as well as published data.

Results In male patients, the optimal age to stop surveillance was 76–78 years irrespective of the IPMN types, compared with 70, 73, 81, and 84 years for female patients with branch-duct IPMNs <20 mm, =20–29 mm, ≥30 mm and mixed-type IPMNs, respectively. The suggested ages became younger according to an increasing level of comorbidities. In cases with high comorbidity burden, the ICERs were above the willingness-to-pay threshold irrespective of sex and the size of branch-duct IPMNs.

Conclusions The cost-effectiveness of long-term IPMN surveillance depended on sex, IPMN types, and comorbidity levels, suggesting the potential to personalise patient management from the health economic perspective.

  • carcinogenesis
  • pancreatic cancer
  • cost-effectiveness
  • surveillance
  • pancreatic tumours

Data availability statement

The deidentified data on a clinical cohort at The University of Tokyo Hospital and analytic methods used in the current study will be available from the corresponding author upon reasonable request. The datasets from the Diagnosis Procedure Combination database analysed during the current study are not publicly available due to contracts with the hospitals providing the data.

https://doi.org/10.1136/gutjnl-2023-330329

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    Data availability statement

    The deidentified data on a clinical cohort at The University of Tokyo Hospital and analytic methods used in the current study will be available from the corresponding author upon reasonable request. The datasets from the Diagnosis Procedure Combination database analysed during the current study are not publicly available due to contracts with the hospitals providing the data.

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    Footnotes

    • Contributors TH, HO, ML and YN developed the main concept, designed the study and participated in the literature search. TH, YN, KF and HY produced financial support. TH, HO, YK, HM, NM, YN, KF and HY were responsible for the acquisition of data. TH, HO, AI, YK, ML, YN and HY analysed and interpreted the data. TH drafted the manuscript. HO, AI, YK, ML, HM, NM, YN, KF, HY and MF contributed to the editing and critical revision of important intellectual contents. HM, NM, KF, HY and MF provided administrative, technical or material support. YN and MF supervised the study. TH served as the guarantor of the study. All authors read and approved the final version of the report.

    • Funding This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI grants (JP19K08362 and JP22H02841 to TH), by the Practical Research for Innovative Cancer Control Program from AMED (JP21ck0106557 toYN), and by grants from Takeda Science Foundation (to TH); the Ministry of Health, Labour and Welfare, Japan (22AA2003 to KF and 21AA2007 and 22AA2005 to HY); and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907 to HY). The funders had no role in study design, data collection andanalysis, the decision to publish or the preparation of the manuscript.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.