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Modelling the benefits of early diagnosis of pancreatic cancer using a biomarker signature

Pancreatic cancer (PC) has a poor prognosis, with a 5‐year survival of 3–4%. This is mainly due to late diagnosis because of diffuse symptoms, where 80–85% of the patients are inoperable. Consequently, early diagnosis would be of significant benefit, resulting in a potential 5‐year survival of 30–40%. However, new technologies must be carefully evaluated concerning effectiveness and healthcare costs. We have developed a framework for modelling cost and health effects from early detection of PC, which for the first time allowed us to analyse its cost‐effectiveness. A probabilistic cohort model for estimating costs and quality adjusted life‐years (QALY) arising from screening for PC, compared to a “wait‐and‐see”‐approach, was designed. The test accuracy, Swedish survival and costs by tumour stage, expected life gain from early detection and pretest probabilities in risk groups, were retrieved from previous investigations. In a cohort of newly diagnosed diabetic patient (incidence 0.71%) the incremental cost per QALY gained (ICER) was €13,500, which is considered cost‐effective in Europe. Results were mainly sensitive to the incidence with the ICER ranging from €315 to €204,000 (familial PC 35% and general population 0.046%, respectively). This is the first study focusing on clinical implementation of advanced testing and what is required for novel technologies in cancer care to be cost‐effective. The model clearly demonstrated the potential of multiplexed proteomic‐testing of PC and also identified the requirements for test accuracy. Consequently, it can serve as a model for assessing the possibilities to introduce advanced test platforms also for other cancer indications.