{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T20:15:30Z","timestamp":1792700130803,"version":"4.5.0"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Pancreatic ductal adenocarcinoma (PDAC) is often diagnosed late, resulting in a dismal survival. Only 1 in 5 patients is eligible for potentially curative surgery. Although earlier detection of PDAC could significantly improve prognosis, population-wide screening is not currently feasible. Individuals at high risk, such as those with new-onset diabetes, among whom approximately 10% have type 3c diabetes (T3cD) and 1% have undiagnosed PDAC, could represent a target population for PDAC screening.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the cost-effectiveness of 3 PDAC screening strategies in new-onset diabetes with the standard of care.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>For this economic evaluation, a Markov state-transition decision model was developed to assess the downstaging benefits associated with screening policies over a 5-year period. The model allowed for diagnosis of resectable, borderline resectable, locally advanced, or metastatic disease. Model parameters were subject to 1-way and multiway sensitivity analyses. Mean treatment costs were extracted from the UK National Healthcare Service cost-collection data (2021-2022), and the screening strategies were applied to a simulated cohort of individuals aged 50 years or older with new-onset diabetes in the UK. Analyses were performed from August 2024 to January 2025.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Pancreatic ductal adenocarcinoma screening strategies included the use of a T3cD biomarker, a cancer-specific biomarker, or a combination of a T3cD biomarker followed by a cancer-specific test in the population with new-onset diabetes. Biomarker cohorts were compared with the standard-of-care cohort undergoing diagnostic investigations on the development of clinical symptoms.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Per-person incremental cost-effectiveness ratios (ICERs) and net benefits were calculated, allowing for a willingness-to-pay threshold per quality-adjusted life-year (QALY) of \u00a330\u202f000 (US $40\u202f156), as accepted by the UK\u2019s National Institute for Health and Care Excellence.<\/jats:p><\/jats:sec>Results<\/jats:title>Among individuals aged 50 years or older with new-onset diabetes, neither the cancer-specific nor T3cD biomarker strategy was cost-effective compared with the standard of care, with an ICER per QALY of \u00a371\u202f906 (US $96\u202f249) for the cancer-specific biomarker test and an ICER per QALY of \u00a346\u202f371 (US $62\u202f070) for the T3cD biomarker strategy. Sequential use of a T3cD biomarker and a cancer-specific biomarker approached cost-effectiveness (ICER per QALY, \u00a334\u202f223 [US $45\u202f809]), with 2.4 scans performed to detect 1 PDAC case among 200\u202f000 people with new-onset diabetes. Sensitivity analyses highlighted biomarker specificity as a critical determinant of cost-effectiveness.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this economic evaluation of early PDAC detection among individuals with new-onset diabetes, the application of a primary T3cD biomarker followed by a secondary PDAC-specific test was more cost-effective than the sole use of either biomarker, although no strategy was cost-effective compared with standard of care. These findings can be used to inform biomarker-associated early detection strategies for PDAC.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.38031","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T15:30:29Z","timestamp":1760715029000},"page":"e2538031","source":"Crossref","is-referenced-by-count":7,"title":["Cost-Effectiveness of Biomarker-Associated Early Pancreatic Cancer Detection in New-Onset Diabetes"],"prefix":"10.1001","volume":"8","author":[{"given":"Irena","family":"Stefanova","sequence":"first","affiliation":[{"name":"Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom"},{"name":"Department of Pancreas Surgery, Royal Liverpool Hospital NHS Foundation Trust, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Thompson","sequence":"additional","affiliation":[{"name":"Management Science, University of Strathclyde, 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