Cost-effectiveness analysis of including contrast-enhanced ultrasound in management of pancreatic cystic neoplasms

Purpose Pancreatic cystic neoplasms (PCN) management consists of non-invasive imaging studies (CT, MRI), with a high resource burden. We aimed to determine the cost-effectiveness of including contrast-enhanced ultrasound (CEUS) in the management of PCN without risk features. Materials and methods By using a decision-tree model in a hypothetical cohort of patients, we compared management strategy including CEUS with the latest Fukuoka consensus, European and Italian guidelines. Our strategy for BD-IPMN/MCN < 1 cm includes 1 CEUS annually. For those between 1 and 2 cm, it includes CEUS 4 times/year during the first year, then 3 times/year for 4 years and then annually. For those between 2 and 3 cm, it comprises MRI twice/year during the first one, then alternating 2 CEUS and 1 MRI yearly. Results CEUS surveillance is the dominant strategy in all scenarios. CEUS surveillance average cost is 1,984.72 euro, mean QALY 11.79 and mean ICER 181.99 euro. If willingness to pay is 30,000 euro, 45% of patients undergone CEUS surveillance of BDIPMN/MCN < 1 cm would be within budget. Conclusion Guidelines strategies are very effective, but costs are relatively high from a policy perspective. CEUS surveillance may be a cost-effective strategy yielding a nearly high QALYs, an acceptable ICER, and a lower cost.