Cost-effectiveness of biomarker-associated early pancreatic cancer detection in new-onset diabetes

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Stefanova, Irena and Thompson, Nathan and Oldfield, Lucy and Stott, Martyn and Hanson, Robert and Palmer, Daniel and Halloran, Christopher and Greenhalf, William and Van Der Meer, Robert and Costello, Eithne (2025) Cost-effectiveness of biomarker-associated early pancreatic cancer detection in new-onset diabetes. JAMA Network Open, 8 (10). e2538031. ISSN 2574-3805 (https://doi.org/10.1001/jamanetworkopen.2025.38031)

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Abstract

Importance: Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed late, resulting in a dismal survival. Only 1 in 5 patients is eligible for potentially curative surgery. Although earlier detection of PDAC could significantly improve prognosis, population-wide screening is not currently feasible. Individuals at high risk, such as those with new-onset diabetes, among whom approximately 10% have type 3c diabetes (T3cD) and 1% have undiagnosed PDAC, could represent a target population for PDAC screening. Objective: To compare the cost-effectiveness of 3 PDAC screening strategies in new-onset diabetes with the standard of care. Design, Setting, and Participants: For this economic evaluation, a Markov state-transition decision model was developed to assess the downstaging benefits associated with screening policies over a 5-year period. The model allowed for diagnosis of resectable, borderline resectable, locally advanced, or metastatic disease. Model parameters were subject to 1-way and multiway sensitivity analyses. Mean treatment costs were extracted from the UK National Healthcare Service cost-collection data (2021-2022), and the screening strategies were applied to a simulated cohort of individuals aged 50 years or older with new-onset diabetes in the UK. Analyses were performed from August 2024 to January 2025. Exposures: Pancreatic ductal adenocarcinoma screening strategies included the use of a T3cD biomarker, a cancer-specific biomarker, or a combination of a T3cD biomarker followed by a cancer-specific test in the population with new-onset diabetes. Biomarker cohorts were compared with the standard-of-care cohort undergoing diagnostic investigations on the development of clinical symptoms. Main Outcomes and Measures: Per-person incremental cost-effectiveness ratios (ICERs) and net benefits were calculated, allowing for a willingness-to-pay threshold per quality-adjusted life-year (QALY) of £30 000 (US $40 156), as accepted by the UK’s National Institute for Health and Care Excellence. Results: Among individuals aged 50 years or older with new-onset diabetes, neither the cancer-specific nor T3cD biomarker strategy was cost-effective compared with the standard of care, with an ICER per QALY of £71 906 (US $96 249) for the cancer-specific biomarker test and an ICER per QALY of £46 371 (US $62 070) for the T3cD biomarker strategy. Sequential use of a T3cD biomarker and a cancer-specific biomarker approached cost-effectiveness (ICER per QALY, £34 223 [US $45 809]), with 2.4 scans performed to detect 1 PDAC case among 200 000 people with new-onset diabetes. Sensitivity analyses highlighted biomarker specificity as a critical determinant of cost-effectiveness. Conclusions and Relevance: In this economic evaluation of early PDAC detection among individuals with new-onset diabetes, the application of a primary T3cD biomarker followed by a secondary PDAC-specific test was more cost-effective than the sole use of either biomarker, although no strategy was cost-effective compared with standard of care. These findings can be used to inform biomarker-associated early detection strategies for PDAC.

ORCID iDs

Stefanova, Irena, Thompson, Nathan, Oldfield, Lucy, Stott, Martyn, Hanson, Robert, Palmer, Daniel, Halloran, Christopher, Greenhalf, William, Van Der Meer, Robert ORCID logoORCID: https://orcid.org/0000-0002-9442-1628 and Costello, Eithne;
CORE (COnnecting REpositories)