BACKGROUND: In treating pancreatic cancer, there is no clearly defined optimal sequence of chemotherapy, radiation therapy and surgery. Therefore, cost-effectiveness should be considered. The objective of this study was to compare cost and outcomes between a surgery-first approach versus neoadjuvant chemoradiation followed by surgery for resectable pancreatic head cancer. METHODS: A decision analytic model was constructed to compare the 2 approaches. Data from the National Cancer Database, National Surgical Quality Improvement Program, and literature populated the surgery-first arm. Data from our prospectively maintained institutional pancreatic cancer database populated the neoadjuvant arm. Costs were estimated by Medicare payment (2011 U.S. dollars). Survival was reported in quality-adjusted life-months (QALMs). RESULTS: The neoadjuvant chemoradiation arm consisted of 164 patients who completed preoperative therapy. Of these, 36 (22 %) did not proceed to surgery; 12 (7 %) underwent laparotomy but had unresectable disease; and 116 (71 %) underwent definitive resection. The surgery-first approach cost $46,830 and yielded survival of 8.7 QALMs; the neoadjuvant chemoradiation approach cost $36,583 and yielded survival of 18.8 QALMs. In the neoadjuvant arm, costs and survival times for patients not undergoing surgery, those with unresectable disease at laparotomy, and those completing surgery were $12,401 and 7.7 QALMs, $20,380 and 7.1 QALMs, and $45,673 and 23.4 QALMs, respectively. CONCLUSIONS: Neoadjuvant chemoradiation for pancreatic cancer identifies patients with early metastases or poor performance status, who can be spared an ineffective or prohibitively morbid operation, and is associated with improved survival at significantly lower cost than a surgery-first approach. Neoadjuvant chemoradiation followed by surgery is a strategy that provides more cost-effective care than a surgery-first approach.
BACKGROUND: In treating pancreatic cancer, there is no clearly defined optimal sequence of chemotherapy, radiation therapy and surgery. Therefore, cost-effectiveness should be considered. The objective of this study was to compare cost and outcomes between a surgery-first approach versus neoadjuvant chemoradiation followed by surgery for resectable pancreatic head cancer. METHODS: A decision analytic model was constructed to compare the 2 approaches. Data from the National Cancer Database, National Surgical Quality Improvement Program, and literature populated the surgery-first arm. Data from our prospectively maintained institutional pancreatic cancer database populated the neoadjuvant arm. Costs were estimated by Medicare payment (2011 U.S. dollars). Survival was reported in quality-adjusted life-months (QALMs). RESULTS: The neoadjuvant chemoradiation arm consisted of 164 patients who completed preoperative therapy. Of these, 36 (22 %) did not proceed to surgery; 12 (7 %) underwent laparotomy but had unresectable disease; and 116 (71 %) underwent definitive resection. The surgery-first approach cost $46,830 and yielded survival of 8.7 QALMs; the neoadjuvant chemoradiation approach cost $36,583 and yielded survival of 18.8 QALMs. In the neoadjuvant arm, costs and survival times for patients not undergoing surgery, those with unresectable disease at laparotomy, and those completing surgery were $12,401 and 7.7 QALMs, $20,380 and 7.1 QALMs, and $45,673 and 23.4 QALMs, respectively. CONCLUSIONS: Neoadjuvant chemoradiation for pancreatic cancer identifies patients with early metastases or poor performance status, who can be spared an ineffective or prohibitively morbid operation, and is associated with improved survival at significantly lower cost than a surgery-first approach. Neoadjuvant chemoradiation followed by surgery is a strategy that provides more cost-effective care than a surgery-first approach.
Authors: Sun Mi Lee; Matthew H G Katz; Li Liu; Manonmani Sundar; Hua Wang; Gauri R Varadhachary; Robert A Wolff; Jeffrey E Lee; Anirban Maitra; Jason B Fleming; Asif Rashid; Huamin Wang Journal: Am J Surg Pathol Date: 2016-12 Impact factor: 6.394
Authors: Gursharan K Sohi; Jordan Levy; Victoria Delibasic; Laura E Davis; Alyson L Mahar; Elmira Amirazodi; Craig C Earle; Julie Hallet; Ahmed Hammad; Rajan Shah; Nicole Mittmann; Natalie G Coburn Journal: Eur J Health Econ Date: 2021-03-09
Authors: Thejus T Jayakrishnan; Hasan Nadeem; Ryan T Groeschl; Ben George; James P Thomas; Paul S Ritch; Kathleen K Christians; Susan Tsai; Douglas B Evans; Sam G Pappas; T Clark Gamblin; Kiran K Turaga Journal: HPB (Oxford) Date: 2014-08-15 Impact factor: 3.647
Authors: Brent T Xia; David A Habib; Vikrom K Dhar; Nick C Levinsky; Young Kim; Dennis J Hanseman; Jeffrey M Sutton; Gregory C Wilson; Milton Smith; Kyuran Ann Choe; Jeffrey J Sussman; Syed A Ahmad; Daniel E Abbott Journal: Ann Surg Oncol Date: 2016-07-26 Impact factor: 5.344
Authors: Danielle K DePeralta; Takuya Ogami; Jun-Min Zhou; Michael J Schell; Benjamin D Powers; Pamela J Hodul; Mokenge P Malafa; Jason B Fleming Journal: HPB (Oxford) Date: 2019-09-25 Impact factor: 3.647