Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines

Kevin Verhoeff; Alexandria N Webb; Daniel Krys; Danielle Anderson; David L Bigam; Christopher I Fung

doi:10.1093/jcag/gwad001

Multicentre Analysis of Cost, Uptake and Safety of Canadian Multidisciplinary Pancreatic Cyst Guidelines

J Can Assoc Gastroenterol. 2023 Feb 28;6(2):86-93. doi: 10.1093/jcag/gwad001. eCollection 2023 Apr.

Authors

Kevin Verhoeff¹, Alexandria N Webb², Daniel Krys³, Danielle Anderson⁴, David L Bigam¹, Christopher I Fung⁵

Affiliations

¹ Department of Surgery, 2D2 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada.
² Department of Surgery, McMaster University, Section B3 - Room 143 Juravinski Hospital, 711 Concession Street Hamilton, Ontario L8V 1C3, Canada.
³ Faculty of Medicine and Dentistry, University of Alberta, 8440 - 112 Street Edmonton, Alberta T6G 2B7, Canada.
⁴ Department of Laboratory Medicine and Pathology, 4B1.19 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 - 112 Street Edmonton, Alberta T6G 2B7, Canada.
⁵ Department of Radiology, 2A2 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street Edmonton, Alberta T6G 2B7, Canada.

Abstract

Background: Pancreatic cystic lesions (PCLs) are common, with several guidelines providing surveillance recommendations. The Canadian Association of Radiologists published surveillance guidelines (CARGs) intended to provide simplified, cost-effective and safe recommendations. This study aimed to evaluate cost savings of CARGs compared to other North American guidelines including American Gastroenterology Association guidelines (AGAG) and American College of Radiology guidelines (ACRG), and to evaluate CARG safety and uptake.

Methods: This is a multicentre retrospective study evaluating adults with PCL from a single health zone. MRIs completed from September 2018-2019, one year after local CARG guideline implementation, were reviewed to identify PCLs. All imaging following 3-4 years of CARG implementation was reviewed to evaluate true costs, missed malignancy and guideline uptake. Modelling, including MRI and consultation, predicted and compared costs associated with surveillance based on CARGs, AGAGs and ACRGs.

Results: 6698 abdominal MRIs were reviewed with 1001 (14.9%) identifying PCL. Application of CARGs over 3.1 years demonstrated a >70% cost reduction compared to other guidelines. Similarly, the modelled cost of surveillance for 10-years for each guideline was $516,183, $1,908,425 and $1,924,607 for CARGs, AGAGs and ACRGs respectively. Of patients suggested to not require further surveillance per CARGs, approximately 1% develop malignancy with fewer being candidates for surgical resection. Overall, 44.8% of initial PCL reports provided CARG recommendations while 54.3% of PCLs were followed as per CARGs.

Conclusions: CARGs are safe and offer substantial cost and opportunity savings for PCL surveillance. These findings support Canada-wide implementation with close monitoring of consultation requirements and missed diagnoses.

Keywords: Cost savings; Guidelines; MRI; Pancreatic cyst; Surveillance.