Objective Current guidelines recommend long-term image-based surveillance for patients with low-risk intraductal papillary mucinous neoplasms (IPMNs). This simulation study aimed to examine the comparative cost-effectiveness of continued versus discontinued surveillance at different ages and define the optimal age to stop surveillance. Design We constructed a Markov model with a lifetime horizon to simulate the clinical course of patients with IPMNs receiving imaging-based surveillance. We calculated incremental cost-effectiveness ratios (ICERs) for continued versus discontinued surveillance at different ages to stop surveillance, stratified by sex and IPMN types (branch-duct vs mixed-type). We determined the optimal age to stop surveillance as the lowest age at which the ICER exceeded the willingness-to-pay threshold of US$100 000 per quality-adjusted life year. To estimate model parameters, we used a clinical cohort of 3000 patients with IPMNs and a national database including 40 166 patients with pancreatic cancer receiving pancreatectomy as well as published data. Results In male patients, the optimal age to stop surveillance was 76–78 years irrespective of the IPMN types, compared with 70, 73, 81, and 84 years for female patients with branch-duct IPMNs <20 mm, =20–29 mm, ≥30 mm and mixed-type IPMNs, respectively. The suggested ages became younger according to an increasing level of comorbidities. In cases with high comorbidity burden, the ICERs were above the willingness-to-pay threshold irrespective of sex and the size of branch-duct IPMNs. Conclusions The cost-effectiveness of long-term IPMN surveillance depended on sex, IPMN types, and comorbidity levels, suggesting the potential to personalise patient management from the health economic perspective. The deidentified data on a clinical cohort at The University of Tokyo Hospital and analytic methods used in the current study will be available from the corresponding author upon reasonable request. The datasets from the Diagnosis Procedure Combination database analysed during the current study are not publicly available due to contracts with the hospitals providing the data.

中文翻译：

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停止导管内乳头状粘液性肿瘤长期监测的最佳年龄：按年龄进行监测的比较成本效益

目的 当前指南建议对低风险导管内乳头状粘液性肿瘤 (IPMN) 患者进行长期基于图像的监测。这项模拟研究旨在检查不同年龄持续监测与停止监测的比较成本效益，并确定停止监测的最佳年龄。设计 我们构建了一个具有生命周期的马尔可夫模型来模拟接受基于成像的监测的 IPMN 患者的临床病程。我们计算了不同年龄持续监测与停止监测的增量成本效益比 (ICER)，按性别和 IPMN 类型（分支管型与混合型）分层。我们将停止监测的最佳年龄确定为 ICER 超过每个质量调整生命年 10 万美元的支付意愿门槛的最低年龄。为了估计模型参数，我们使用了 3000 名 IPMN 患者的临床队列和一个国家数据库，其中包括 40166 名接受胰腺切除术的胰腺癌患者以及已发表的数据。结果 在男性患者中，无论 IPMN 类型如何，停止监测的最佳年龄为 76-78 岁，而分支管 IPMN <20 mm，=20-29 mm 的女性患者停止监测的最佳年龄为 70、73、81 和 84 岁、≥30 mm 和混合型 IPMN。根据合并症水平的增加，建议的年龄变得更年轻。在合并症负担较高的病例中，无论性别和分支导管 IPMN 的大小如何，ICER 都高于支付意愿阈值。结论 长期 IPMN 监测的成本效益取决于性别、IPMN 类型和合并症水平，这表明从健康经济学角度个性化患者管理的潜力。东京大学医院临床队列的去识别化数据和当前研究中使用的分析方法将根据合理要求从相应作者处获得。由于与提供数据的医院签订了合同，当前研究期间分析的诊断程序组合数据库的数据集尚未公开。