Threshold Analysis of the Cost-effectiveness of Endoscopic Ultrasound in Patients at High Risk for Pancreatic Ductal Adenocarcinoma

Shria Kumar, Monica Saumoy, Aaron Oh, Yecheskel Schneider, Randall E. Brand, Amitabh Chak, Gregory G. Ginsberg, Michael L. Kochman, Marcia Irene Canto, Michael Gilbert Goggins, Chin Hur, Fay Kastrinos, Bryson W. Katona, Anil K. Rustgi

Research output: Contribution to journalArticlepeer-review


Objectives Data from the International Cancer of the Pancreas Screening Consortium studies have demonstrated that screening for pancreatic ductal adenocarcinoma can be effective and that surveillance improves survival in high-risk individuals. Endoscopic ultrasound (EUS) and cross-sectional imaging are both used, although there is some suggestion that EUS is superior. Demonstration of the cost-effectiveness of screening is important to implement screening in high-risk groups. Methods Results from centers with EUS-predominant screening were pooled to evaluate efficacy of index EUS in screening. A decision analysis model simulated the outcome of high-risk patients who undergo screening and evaluated the parameters that would make screening cost-effective at a US $100,000 per quality-adjusted life-year willingness to pay. Results One-time index EUS has a sensitivity of 71.25% and specificity of 99.82% to detection to detect high-risk lesions. Screening with index EUS was cost-effective, particularly at lifetime pancreatic cancer probabilities of greater than 10.8%, or at lower probabilities if life expectancy after resection of a lesion that was at least 16 years, and if missed, lesion rates on index EUS are 5% or less. Conclusions Pancreatic cancer screening can be cost-effective through index EUS, particularly for those individuals at high-lifetime risk of cancer.

Original languageEnglish (US)
Pages (from-to)807-814
Number of pages8
Issue number6
StatePublished - 2021


  • CAPS - Cancer of the Pancreas Screening
  • CDC - Centers for Disease Control and Prevention
  • EUS - endoscopic ultrasound
  • FAMMM - familial atypical multiple mole melanoma syndrome
  • FDR - first-degree relatives
  • FPC - familial pancreatic cancer
  • HP - hereditary pancreatitis
  • HRI - high-risk individuals
  • ICER - incremental cost-effectiveness ratio
  • IPMN - intraductal papillary mucinous neoplasia
  • MRI - magnetic resonance imaging
  • NCHS - National Center for Health Statistics
  • PDAC - pancreatic ductal adenocarcinoma
  • PJS - Peutz-Jeghers syndrome
  • PNET - pancreatic neuroendocrine tumor
  • PanIN - pancreatic intraepithelial neoplasia
  • QALY - quality-adjusted life year
  • WTP - willingness to pay
  • cost-effectiveness
  • endoscopic ultrasound
  • familial
  • hereditary
  • pancreatic ductal adenocarcinoma

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology


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