Managing incidental XXXX with integrated molecular pathology is a cost-effective strategy.

@entity1 @entity788 @entity5 @entity660 @entity787 @entity45
BACKGROUND AND STUDY AIMS: Current guidelines recommend using endoscopic ultrasound (EUS), @entity787 ( @entity787 ) testing and cytology to manage incidental @entity788 ( @entity788 ); however, studies suggest a strategy including integrated molecular pathology (IMP) of cyst fluid may further aid in predicting risk of @entity5 . Here, we evaluate several strategies for diagnosing and managing asymptomatic @entity788 using healthcare economic modeling. @entity1 AND METHODS: A third-party-payer perspective Markov decision model examined four management strategies in a hypothetical cohort of 1000 asymptomatic @entity1 incidentally found to have a 3cm solitary @entity660 . Strategy I used cross-sectional imaging, recommended surgery only if symptoms or risk factors emerged. Strategy II considered @entity1 for resection without initial EUS.Strategy III (EUS+ @entity787 +Cytology) referred only those with @entity45 ( @entity787 >192ng/mL) for resection. Strategy IV implemented IMP; a commercially available panel provided a "Benign," "Mucinous," or "Aggressive" classification based on the level of mutational change in cyst fluid. "Benign" and "Mucinous" @entity1 were followed with surveillance; "Aggressive" @entity1 were referred for resection. Quality-adjusted life-years (QALY), relative risk with 95%CI, Number Needed to Treat (NNT), and incremental cost-effectiveness ratios were calculated. RESULTS: Strategy IV provided the greatest increase in QALY at nearly identical cost to the cheapest approach, Strategy I. Relative risk of @entity5 compared to the current standard of care and nearest competing strategy, Strategy III, was 0.18 (95%CI 0.06-0.53) with an NNT of 56 (95%CI 34-120). CONCLUSIONS: Use of IMP was the most cost-effective strategy, supporting its routine clinical use.
