Endoscopic Ultrasound in the Clinical Staging and Management of Pancreatic Cancer: Its Impact on Cost of Treatment

Mark E. Powis, MD, and Kenneth J. Chang, MD, Division of Gastroenterology at the University of Colorado Health Sciences Center, Denver, Colo (MEP), and the Gastrointestinal Oncology Program at the University of California, Irvine Medical Center, Orange, Calif (KJC).

Cancer Control. 2000;7(5) 

In This Article

Background and Economic Impact of Pancreatic Cancer

Pancreatic cancer occurs in approximately 29,000 patients per year and is the fourth leading cause of cancer related-mortality. [1,2] Despite recent advances in perioperative management, 5-year survival rates remain essentially unchanged from a historical 5-year survival of 5%. [3] Identifying patients who would best benefit from a surgical procedure as opposed to palliative treatment has remained problematic. Despite the best efforts, most patients are found to have unresectable tumors at the time of surgery.

The economic impact of pancreatic cancer is also of great concern. However, information about the costs of pancreatic cancer is limited. In a recent analysis using a prevalence approach method by Wilson and Lightwood, [4] the direct medical care costs in the United States were estimated to be $881 million annually. In this series, direct medical costs referred to three components: hospitalization costs, outpatient costs (eg, medications, transportation, medical equipment, and supplies), and home and long-term care. In total, 84% of direct medical costs were related to hospitalization costs. Long-term care costs accounted for 14%, and out-patient costs accounted for 9% of direct medical costs (Fig 1A). Of hospitalization costs, room and board accounted for 45% of costs, surgery for 9%, and radiology for 10% (Fig 1B).

Estimated costs associated with pancreatic cancer treatment, with 84% of direct medical costs relating to hospitalization costs. (A) Breakdown of direct medical costs associated with hospital, outpatient, and long-term care costs. (B) Breakdown of hospital costs associated with room/board, medications, laboratory, surgery, radiology, and miscellaneous. Data from Wilson and Lightwood. [4]

The average costs for admissions with major surgery were more than three times greater than for those without major surgery -- $22,546 and $7,188, respectively. As with most medical costs, inpatient care represents the majority of costs. [4] Effectively dividing patients into surgical and palliative treatment groups clearly has economic repercussions.

Another analysis found that pancreatic cancer costs amounted to $2.6 billion in total health care costs, accounting for 1.8% of the entire cost of caring for all cancer patients in the United States. [5] In the analysis by Wilson and Lightwood, [4] total annual costs in the United States, including direct medical costs and indirect costs (costs due to lost wages, lost employment, and lost activity days) accounted for $4.9 billion lost annually. A great deal of resources are lost directly and indirectly as a result of pancreatic cancer.

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