ArticleSurgery2020
Cost-effectiveness of consensus guideline based management of pancreatic cysts: The sensitivity and specificity required for guidelines to be cost-effective.
Article in Surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- Economic evaluations of early detection strategies for pancreatic cancer: a systematic review.The European journal of health economics : HEPAC : health economics in prevention and care · 2025Pooled it
- Small cyst size and lack of growth as negative predictors of malignant transformation in low-risk intraductal papillary mucinous neoplasms of the pancreas: A systematic review and meta-analysis.United European gastroenterology journal · 2025Pooled it
- Pancreatic cystic lesions revisited: morphologic patterns and diagnostic pitfalls in daily practice.Abdominal radiology (New York) · 2026Review
- Article
- Uncertainty-Aware Explainable AI for Pancreatic Cysts: Identifying Deep Learning Vulnerabilities and Ensuring Safe Clinical Triage in IPMN Management.Research square · 2026Article
- Prevalence and Size-Based Risk Categorization of Pancreatic Cysts Among Asymptomatic Individuals With Screening MRI.JAMA network open · 2026Article
- Endoscopic ultrasound-guided radiofrequency ablation for large branch-duct intraductal papillary mucinous neoplasms: Safety and efficacy trial.Endoscopy international open · 2026Article
- Cystic tumors of the pancreas: Current perspectives on diagnosis and management.World journal of gastroenterology · 2025Review
- Towards automating risk stratification of intraductal papillary mucinous Neoplasms: Artificial intelligence advances beyond human expertise with confocal laser endomicroscopy.Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] · 2025Article
- Exploring the new Kyoto guidelines for managing pancreatic cysts: an overview and comparison with previous guidelines.Abdominal radiology (New York) · 2025Review
- Mucinous cystic neoplasm mimicking pancreatic pseudocyst and progressing to adenocarcinoma: A case report.World journal of gastrointestinal oncology · 2025Article
- Misdiagnosis of pancreatic intraductal papillary mucinous neoplasms and the challenge of mimicking lesions: imaging diagnosis and differentiation strategies.Abdominal radiology (New York) · 2025Review
- Current Considerations in Nonoperative Surveillance of Intraductal Papillary Mucinous Neoplasms.Digestive disease interventions · 2025Article
- The Effectiveness of Endoscopic Ultrasonography and Computed Tomography in the Differentiation of Pancreatic Cystic Neoplasms: A Single-Center Experience.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2024Article
- Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation.Gastroenterology · 2023Article
- Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis.Cancers · 2023Review
- Addressing the unmet clinical need for low-volume assays in early diagnosis of pancreatic cancer.Frontiers in gastroenterology (Lausanne, Switzerland) · 2023Article
- Recent advances in nanomedicine preparative methods and their therapeutic potential for colorectal cancer: a critical review.Frontiers in oncology · 2023Review
- A Systematic Comparative Study on the Diagnostic Value of Transabdominal Ultrasound in Patients with Pancreatic Cystic Lesions.Journal of clinical medicine · 2022Article
- Pancreatic cystic neoplasms and post-inflammatory cysts: interobserver agreement and diagnostic performance of MRI with MRCP.Abdominal radiology (New York) · 2021Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundDetection of cystic lesions of the pancreas has outpaced our ability to stratify low-grade cystic lesions from those at greater risk for pancreatic cancer, raising a concern for overtreatment.
methodsWe developed a Markov decision model to determine the cost-effectiveness of guideline-based management for asymptomatic pancreatic cysts. Incremental costs per quality-adjusted life year gained and survival were calculated for current management guidelines. A sensitivity analysis estimated the effect on cost-effectiveness and mortality if overtreatment of low-grade cysts is avoided, and the sensitivity and specificity thresholds required of methods of cyst stratification to improve costs expended.
results"Surveillance" using current management guidelines had an incremental cost-effectiveness ratio of $171,143/quality adjusted life year compared with no surveillance or operative treatment ("do nothing"). An incremental cost-effectiveness ratio for surveillance decreases to $80,707/quality adjusted life year if the operative overtreatment of low-grade cysts was avoided. Assuming a societal willingness-to-pay of $100,000/quality adjusted life year, the diagnostic specificity for high-risk cysts must be >67% for surveillance to be preferred over surgery and "do nothing." Changes in sensitivity alone cannot make surveillance cost-effective. Most importantly, survival in surveillance is worse than "do nothing" for 3 years after cyst diagnosis, although long-term survival is improved. The disadvantage is eliminated when overtreatment of low-grade cysts is avoided.
conclusionCurrent management of pancreatic cystic lesions is not cost-effective and may increase mortality owing to overtreatment of low-grade cysts. The specificity for risk stratification for high-risk cysts must be greater than 67% to make surveillance cost-effective.
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Registered trials
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