Determining the cost‐effectiveness of endoscopic surveillance for gastric cancer in patients with precancerous lesions

Wu, Jin; Zhou, Jun; Naidoo, Nasheen; Wen, Yang; Lin, Xiao Cheng; Wang, Pei; Ding, Jin Qin; Wu, Chen; Zhou, Hui

doi:10.1111/ajco.12569

Cited by 17 publications

(18 citation statements)

References 44 publications

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“…Using an adapted WTP threshold of $44,000/QALY, they reported that the one-time screening with select annual surveillance was cost-effective (ICER: $34,000/QALY) while biennial screening was not cost-effective (ICER: $525,900/QALY). 48 Table 3 details additional model comparisons of various base case age and sex combinations, all of which consistently demonstrated that screening with annual surveillance if indicated generated lower ICERs compared with the biennial strategy. Subgroup analysis, however, demonstrated that cost-effectiveness was heterogenous across combinations of age group and sex.…”

Section: Resultsmentioning

confidence: 83%

“…A total of 17 articles were ultimately included for qualitative analysis; 8 studies were decision analyses of endoscopic screening for GC, 33 – 40 4 were decision analyses of endoscopic surveillance of gastric preneoplasia, 41 – 44 and 5 were decision analyses of both screening and surveillance. 45 – 49 Whereas 6 studies were from high-incidence countries, 34 , 35 , 37 – 40 11 were from low–intermediate incidence countries 33 , 36 , 41 – 49 as defined by IARC. Details of each of these studies are provided in Tables 1 – 3 .…”

Section: Resultsmentioning

confidence: 99%

“…Five studies meeting inclusion criteria consisted of study designs that included endoscopic screening followed by endoscopic surveillance if indicated, with two studies conducted in an overall intermediate incidence country (Singapore) 48 , 49 and three studies in an overall low incidence country (US). 45 – 47 Four were CEAs 46 – 49 and one was a CUA. 45 All used Markov models.…”

Section: Resultsmentioning

confidence: 99%

“…Both CEAs conducted in Singapore analyzed a higher risk sub-population of Singaporean Chinese males and females aged 50–69 years old. 48 , 49 Wu et al compared three screening strategies: EGD for screening every 2 years, EGD with screening and annual surveillance only if patients were identified to have an ulcer or a precancerous mucosal changes (AG, GIM, or dysplasia), and no screening. Using an adapted WTP threshold of $44,000/QALY, they reported that the one-time screening with select annual surveillance was cost-effective (ICER: $34,000/QALY) while biennial screening was not cost-effective (ICER: $525,900/QALY).…”

Section: Resultsmentioning

confidence: 99%

“…Using an adapted WTP threshold of $44,000/QALY, they reported that the onetime screening with select annual surveillance was cost-effective (ICER: $34,000/QALY) while biennial screening was not cost-effective (ICER: $525,900/QALY). 48 The other CEA conducted in Singapore, by Zhou et al, compared five intervention strategies: no screening, yearly EGD surveillance for patients with precancerous mucosal changes, biennial EGD surveillance of patients diagnosed with precancerous mucosal changes, biennial EGD screening, and biennial screening plus annual surveillance. 49 The authors did not specify which premalignant changes were being surveyed.…”

Section: Decision Analyses Of Combined Gc Screening and Gastric Prenementioning

confidence: 99%

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Decision model analyses of upper endoscopy for gastric cancer screening and preneoplasia surveillance: a systematic review

Canakis

Pani

Saumoy

et al. 2020

Therap Adv Gastroenterol

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Aims: Gastric cancer (GC) is the third leading cause of cancer death worldwide, but the burden of disease is not distributed evenly. GC screening routinely occurs in some high-incidence regions/countries and is generally cost-effective, which is attributed largely to the associated GC mortality reduction. In regions of low–intermediate incidence, less is known about the outcomes of GC screening and gastric precancer surveillance, including cost-effectiveness, since there are no comparative clinical studies. Decision analytic studies are informative in such instances where logistical limitations preclude “gold standard” study designs. We therefore aimed to conduct a systematic review of decision model analyses focused on endoscopic GC screening or precancer surveillance. Methods: We identified decision model analyses, including cost effectiveness and cost utility studies, of GC screening or preneoplasia surveillance. At minimum, articles were evaluated for: study country; analytic design; population and health states; time horizon; model assumptions; outcomes; threshold value(s) for “cost-effective” determination; and sensitivity analyses. Quality appraisal was performed using a modified Drummond’s analytic scoring system. Data sources were PubMed, Web of Science, Embase, and the Cochrane Library Results: We identified 17 studies (8 screening, 4 surveillance, and 5 screening and surveillance) that met full inclusion criteria. Endoscopic screening in countries of high GC incidence was cost-effective across all studies; targeted screening of high-risk populations within otherwise low-intermediate incidence countries was also generally cost-effective. Surveillance of gastric precancer, including atrophic gastritis or gastric intestinal metaplasia, was generally cost-effective. Most studies had high appraisal scores, with 4 (24%) studies achieving perfect scores on the Drummond scale. Conclusion: Decision model analyses offer a unique mechanism with which to efficiently explore the cost benefit of various prevention and early detection strategies. Based on this comprehensive systematic review, upper endoscopy for GC screening and gastric precancer surveillance might be cost-effective depending on the population and protocol. Focused efforts are especially needed not only to define the optimal approach, but also to define the populations within otherwise low-intermediate regions/countries who might benefit most.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Decision Analyses Of Combined Gc Screening and Gastric Prenementioning

confidence: 99%

See 3 more Smart Citations

Decision model analyses of upper endoscopy for gastric cancer screening and preneoplasia surveillance: a systematic review

Canakis

Pani

Saumoy

et al. 2020

Therap Adv Gastroenterol

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International cost-effectiveness analysis evaluating endoscopic screening for gastric cancer for populations with low and high risk

Ascherman

Hur

2021

Gastric Cancer

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Background Gastric cancer remains one of the 3 most common causes of cancer death worldwide. Understanding the health and economic factors that affect screening cost-effectiveness in different countries will help address when and where it makes most sense to screen for gastric cancer. Methods We performed a cost-effectiveness analysis using a Markov model to compare screening and surveillance strategies for gastric cancer in Brazil, France, Japan, Nigeria, and the United States. Primary outcome was the incremental costeffectiveness ratio. We then performed a sensitivity analysis to determine how each variable affected the overall model. Results In all countries, the most cost-effective strategies, measured by incremental cost-effectiveness ratio relative to no screening, were screening every 10 years, surveillance of high-and low-risk patients every 5 and 10 years, respectively, and screening every 5 years. Only Japan had at least one cost-effective screening strategy. The most important variables across different screening strategies and countries were starting age of screening, cost of endoscopy, and baseline probability of local gastric cancer at time of diagnosis. Conclusions Our model suggests that screening for gastric cancer is cost-effective in countries with higher incidence and lower costs of screening, but screening may still be a viable option in high-risk populations within low incidence countries.

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Endoscopy Is Cost-Effective for Gastric Cancer Screening After Successful Helicobacter pylori Eradication

Kowada

2021

Dig Dis Sci

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Determining the cost‐effectiveness of endoscopic surveillance for gastric cancer in patients with precancerous lesions

Abstract: Endoscopic surveillance of gastric premalignancies can be a cost-effective strategy for GC prevention. Its implementation requires careful assessment on factors influencing the actual cost-effectiveness.

Cited by 17 publications

References 44 publications

Decision model analyses of upper endoscopy for gastric cancer screening and preneoplasia surveillance: a systematic review

Decision model analyses of upper endoscopy for gastric cancer screening and preneoplasia surveillance: a systematic review

International cost-effectiveness analysis evaluating endoscopic screening for gastric cancer for populations with low and high risk

Endoscopy Is Cost-Effective for Gastric Cancer Screening After Successful Helicobacter pylori Eradication

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