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

• Published in: Journal of the Canadian Association of Gastroenterology 2023-04, Vol.6 (2), p.86-93
• Main Authors: Verhoeff, Kevin, Webb, Alexandria N, Krys, Daniel, Anderson, Danielle, Bigam, David L, Fung, Christopher I
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2515-2084; 2515-2092
• DOI: 10.1093/jcag/gwad001

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. Pancreas cysts are common and have a small chance of becoming cancer. The Canadian guidelines (CARGs) help doctors decide how and when patients should be monitored. This study looks at the cost of CARGs compared to other guidelines. It also looks at the safety of CARGs and if they are easy to use. This study looked at people with pancreatic cysts. After 3–4 years of following CARGs to monitor those people, the costs, missed cancers and guideline use was studied. We studied 1001 people and after using the CARGs for 3.1 years there was a big cost savings. For people that CARGs say don’t need monitoring, only 1% end up having can