S4 Evaluating the Cost of Surveillance in Pancreatic Cysts of Low-Risk Features in Patients Over 70-Years-Old

Introduction: The increasing utilization of high-resolution cross-sectional imaging has led to more incidental diagnoses of pancreatic cysts, particularly in elderly patients. With up to 3 million incidental pancreatic cystic lesions (PCL) diagnosed each year in the United States, there remains a question about the utility and cost associated with surveillance of PCL of low-risk features (LRF) in elderly patients. In our study, we evaluated the cost of current management guidelines of PCLs of LRF in patients over age 70 from a single tertiary-referral center. Methods: A retrospective chart review was performed at our tertiary care referral center from 2012 to 2024 on patients 70-years or older who had a new PCL of LRF diagnosed by computed tomography/magnetic resonance imaging. Patients with low-risk PCLs as defined by Fukuoka Criteria were identified via radiographic imaging reports. This cohort was divided into 2 groups: the no-surveillance group (NSG) (n = 184) with no further imaging after identification of PCL, and the surveillance group (SG) (n = 256) with patients who had 1 or more computed tomography/magnetic resonance imaging after the diagnosis of PCL. The average cost of radiographic scans from our healthcare system was used to estimate the cost per scan. A descriptive statistics model was used to determine the total cost of surveillance. Results: Of the 440 patients identified with PCL of LRF, the SG consisted of 256 patients and NSG comprised of 184 patients. The mean age of the cohort was 79.8 ± 12.1 years. The patients were predominantly white (85.0%) and women (67.1%). Throughout the study period, no patients in either cohort developed pancreatic cancer. The survival time in patient years was 7.04 ± 3.79 for the surveillance group and 5.26 ± 4.03 for the non-surveillance group. The mean number of scans for the surveillance group was 4.72 ± 2.75. The average cost of surveillance in this population was $17,628 per person. The total cost of surveillance in our study was $4,512,813 and over the 13-year study period, $347,139 is projected to be spent on surveillance per year. Conclusion: With the widespread use of radiographic imaging in our healthcare system, an increasing number of PCLs with LRF are being diagnosed in elderly patients. With neither the SG nor the NSG group developing pancreatic cancer, the current management of PCL with LRF in patients newly diagnosed over age 70 is not cost-effective. Re-evaluation of surveillance guidelines and consideration of surveillance cessation in this population may reduce unnecessary healthcare expenditures.