Cost-Effectiveness of a Risk-Based Pancreatic Cancer Early Detection Strategy in New-Onset Diabetes Patients Using a Blood-Based Non-Invasive Test-An Economic Analysis

This study aims to assess the clinical and economic benefits of early detection of pancreatic cancer (PC) in patients with new-onset type 3c diabetes (NOD) using a blood-based, cell-free DNA epigenomic test (Avantect; ClearNote Health, CA). Multiple studies indicate that NOD increases the risk of PC by 6-8 times within the first three years post-diagnosis. A Markov model was created to compare two primary strategies: no testing and testing higher-risk NOD patients using a blood-based cell-free DNA epigenomic test. Additionally, imaging surveillance strategies were also evaluated. Using criteria from Sharma et al. (Gastroenterology, 2018), approximately 20% of the NOD patients were considered to be at higher risk for PC. The risk for developing PC, survival, and cost data were obtained from the US Surveillance, Epidemiology, and End Results (SEER) and Medicare databases. The cell-free DNA epigenomic test has a sensitivity of 68% and a specificity of 97%. It proves robustly cost-effective in NOD high-risk patients, with an Incremental Cost-Effectiveness Ratio (ICER) of $56,564 at a Willingness to Pay (WTP) of $100,000 The model predicts that in a cohort of 10,000 patients with NOD, 1% would be diagnosed with PC in the no-testing strategy, with only 7.1% of cases eligible for surgery. In contrast, 71 PC cases are predicted to be detected with cfDNA testing. These cases would be more likely to be detected at an earlier, more treatable stage, with 32.4% eligible for surgical resection. Testing higher-risk patients with NOD for pancreatic cancer using a blood-based cell-free DNA epigenomic test is predicted to be cost-effective compared to the standard of care (no testing). Initiating this test within three years of a diabetes diagnosis is likely to increase the detection of treatable pancreatic cancer cases, potentially improving patient survival outcomes. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat are the economic benefits of testing for pancreatic cancer (PC) in patients with New-Onset Diabetes using a cfDNA epigenomic test? FindingsMarkov model predicts that of 10,000 hypothetical patients with NOD, 1% would be diagnosed with PC in the no-surveillance strategy, with only 7.1% of cases treatable with surgery. Meanwhile, 71 PC cases are predicted to be detected with cfDNA testing. The latter cases are predicted to be detected at an earlier, more treatable stage, with 32.4% eligible for surgical resection. MeaningcfDNA testing of risk-stratified New-Onset Diabetes patients within 3y of diabetes diagnosis is cost-effective.