Dataset Information

Endoscopic screening for gastric cancer: A cost-utility analysis for countries with an intermediate gastric cancer risk.

ABSTRACT:

Background

Endoscopic screening for gastric cancer is debatable in countries with an intermediate risk.

Objective

The objective of this article is to determine the cost-utility of screening strategies for gastric cancer in a European country.

Methods

We conducted a cost-utility analysis using a Markov model comparing three screening strategies versus no screening: stand-alone upper endoscopy, endoscopy combined with a colorectal cancer screening colonoscopy after a positive faecal occult blood test or pepsinogens serologic screening. Clinical data were collected from systematic reviews, costs from published national data and utilities as quality-adjusted life years (QALY). The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The threshold was set at €37,000 (2016 prices).

Results

Upper endoscopy combined with screening colonoscopy (every 10 or 5 years) had an ICER of 15,407/QALY and €30,908/QALY respectively, stand-alone endoscopic screening (every five years) an ICER of €70,693/QALY and pepsinogens screening an ICER of €143,344/QALY. Sensitivity analyses revealed that only endoscopic costs <€75, a provision of only three endoscopies per patient or a gastric cancer risk >25/100,000 would make stand-alone endoscopic screening cost-effective.

Conclusion

Endoscopic gastric cancer screening in Europe can be cost-effective if combined with a screening colonoscopy in countries with a gastric cancer risk ?10 per 100,000.

SUBMITTER: Areia M

PROVIDER: S-EPMC5833230 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

Endoscopic screening for gastric cancer: A cost-utility analysis for countries with an intermediate gastric cancer risk.

Areia Miguel M Spaander Manon Cw MC Kuipers Ernst J EJ Dinis-Ribeiro Mário M

United European gastroenterology journal 20170718 2

<h4>Background</h4>Endoscopic screening for gastric cancer is debatable in countries with an intermediate risk.<h4>Objective</h4>The objective of this article is to determine the cost-utility of screening strategies for gastric cancer in a European country.<h4>Methods</h4>We conducted a cost-utility analysis using a Markov model comparing three screening strategies versus no screening: stand-alone upper endoscopy, endoscopy combined with a colorectal cancer screening colonoscopy after a positive ...[more]

PMID: 29511549

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Project description:BackgroundGastric cancer (GC) surveillance based on oesophagogastroduodenoscopy (OGD) appears to be a promising strategy for GC prevention. By evaluating the cost-effectiveness of endoscopic surveillance in Singaporean Chinese, this study aimed to inform the implementation of such a program in a population with a low to intermediate GC risk.MethodsUSING A REFERENCE STRATEGY OF NO OGD INTERVENTION, WE EVALUATED FOUR STRATEGIES: 2-yearly OGD surveillance, annual OGD surveillance, 2-yearly OGD screening and 2-yearly screening plus annual surveillance in Singaporean Chinese aged 50-69 years. From a perspective of the healthcare system, Markov models were built to simulate the life experience of the target population. The models projected discounted lifetime costs ($), quality adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) indicating the cost-effectiveness of each strategy against a Singapore willingness-to-pay of $46,200/QALY. Deterministic and probabilistic sensitivity analyses were used to identify the influential variables and their associated thresholds, and to quantify the influence of parameter uncertainties respectively.ResultsWith an ICER of $44,098/QALY, the annual OGD surveillance was the optimal strategy while the 2-yearly surveillance was the most cost-effective strategy (ICER = $25,949/QALY). The screening-based strategies were either extendedly dominated or cost-ineffective. The cost-effectiveness heterogeneity of the four strategies was observed across age-gender subgroups. Eight influential parameters were identified each with their specific thresholds to define the choice of optimal strategy. Accounting for the model uncertainties, the probability that the annual surveillance is the optimal strategy in Singapore was 44.5%.ConclusionEndoscopic surveillance is potentially cost-effective in the prevention of GC for populations at low to intermediate risk. Regarding program implementation, a detailed analysis of influential factors and their associated thresholds is necessary. Multiple strategies should be considered in order to recommend the right strategy for the right population.

Project description:OBJECTIVES:Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. No studies have examined the cost-effectiveness of screening its advanced form, nonalcoholic steatohepatitis (NASH). METHODS:We performed a cost-utility analysis of annual noninvasive screening strategies using third-party payer perspective in a general population in comparison to screening a high-risk obese or diabetic population. Screening algorithms involved well-studied techniques, including NAFLD fibrosis score, transient elastography (TE), and acoustic radiation force impulse (ARFI) imaging for detecting advanced fibrosis (? F3); and plasma cytokeratin (CK)-18 for NASH detection. Liver biopsy and magnetic resonance elastography (MRE) were compared as confirmation methods. Canadian dollar (CAD or C$) costs were adjusted for inflation and discounted at 5%. Incremental cost-effectiveness ratio (ICER) of ?C$ 50,000 was considered cost-effective. RESULTS:Compared with no screening, screening with NAFLD fibrosis score/TE/CK-18 algorithm with MRE as confirmation for advanced fibrosis had an ICER of C$ 26,143 per quality-adjusted life year (QALY) gained. Screening in high-risk obese or diabetic populations was more cost-effective, with an ICER of C$ 9,051 and C$ 7,991 per quality-adjusted life-year (QALY) gained, respectively. Liver biopsy confirmation was not found to be cost-effective. CONCLUSIONS:Our model suggests that annual NASH screening in high-risk obese or diabetic populations can be cost-effective. KEY POINTS:• This cost-utility analysis suggests that screening for nonalcoholic steatohepatitis may be cost-effective. • In particular, screening of high-risk obese or diabetic populations is more cost-effective. • Magnetic resonance elastography was more cost-effective to confirm disease compared to biopsy. • More studies are needed to determine quality of life in nonalcoholic steatohepatitis. • More management strategies for nonalcoholic steatohepatitis are also needed.

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Dataset Information

Endoscopic screening for gastric cancer: A cost-utility analysis for countries with an intermediate gastric cancer risk.

Background

Objective

Methods

Results

Conclusion

Publications

Endoscopic screening for gastric cancer: A cost-utility analysis for countries with an intermediate gastric cancer risk.

Similar Datasets

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