The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas
dc.contributor.author | Tierney, William M. | en_US |
dc.contributor.author | Fendrick, A. Mark | en_US |
dc.contributor.author | Hirth, Richard A. | en_US |
dc.contributor.author | Scheiman, James M. | en_US |
dc.date.accessioned | 2010-06-01T21:34:16Z | |
dc.date.available | 2010-06-01T21:34:16Z | |
dc.date.issued | 2000-07 | en_US |
dc.identifier.citation | Tierney, William M.; Fendrick, A. Mark; Hirth, Richard A.; Scheiman, James M. (2000). "The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas." The American Journal of Gastroenterology 95(7): 1708-1713. <http://hdl.handle.net/2027.42/74623> | en_US |
dc.identifier.issn | 0002-9270 | en_US |
dc.identifier.issn | 1572-0241 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/74623 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=10925972&dopt=citation | en_US |
dc.description.abstract | Several innovative imaging modalities, including endoscopic ultrasound, have increased the number of available preoperative staging methods in patients with adenocarcinoma of the pancreas. Our goal was to estimate the clinical outcomes and cost-effectiveness of alternative staging strategies for pancreatic adenocarcinoma. METHODS : Decision analysis was used to simulate alternative staging strategies. Cost inputs were based on Medicare reimbursements; clinical inputs were obtained from the available literature. Model endpoints of interest were cost per curative resection and appropriateness of treatment allocation based on pathological stage. RESULTS : Endoscopic ultrasound followed by laparoscopy yielded the lowest cost per curative resection ($37,600) and minimized the number of unnecessary surgical explorations (5.4 per 100 patients staged). Requiring angiographic confirmation when endoscopic ultrasound demonstrated an unresectable tumor yielded an intermediate cost-effectiveness ratio and virtually eliminated the risk of overstaging. Laparoscopy alone maximized the resection rate, but each additional resection would cost approximately $2 million relative to a strategy employing both endoscopic ultrasound and angiography. CONCLUSIONS : Staging strategies incorporating endoscopic ultrasound may improve treatment allocation and are cost-effective relative to angiography-based strategies. A staging protocol that does not incorporate an imaging modality to detect vascular invasion dramatically increases the cost per additional curative resection compared with more comprehensive staging protocols. | en_US |
dc.format.extent | 52896 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Science Inc | en_US |
dc.rights | 2000 by Am. Coll. of Gastroenterology | en_US |
dc.title | The clinical and economic impact of alternative staging strategies for adenocarcinoma of the pancreas | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialties | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Division of Gastroenterology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Consortium of Health Outcomes, Innovation, and Cost-effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA | en_US |
dc.identifier.pmid | 10925972 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/74623/1/j.1572-0241.2000.02191.x.pdf | |
dc.identifier.doi | 10.1111/j.1572-0241.2000.02191.x | en_US |
dc.identifier.source | The American Journal of Gastroenterology | en_US |
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dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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