Pancreas
Gut. 2024;73(6):955–65
Optimal age to discontinue long-term surveillance of intraductal papillary mucinous neoplasms: Comparative cost-effectiveness of surveillance by age
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: The authors constructed a Markov model with a lifetime horizon to simulate the clinical course of patients with IPMNs receiving imaging-based surveillance. They 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). The authors 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, they 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 intraductal papillary mucinous neoplasm (IPMN) surveillance depended on sex, IPMN types, and comorbidity levels, suggesting the potential to personalise patient management from the health economic perspective.