Determining the cost‐effectiveness of endoscopic surveillance for gastric cancer in patients with precancerous lesions. Issue 4 (25th July 2016)

• Record Type: Journal Article
• Authors: Wu, Jin Tong; Zhou, Jun; Naidoo, Nasheen; Yang, Wen Yu; Lin, Xiao Cheng; Wang, Pei; Ding, Jin Qin; Wu, Chen Bin; Zhou, Hui Jun
• Is Part Of: Asia-Pacific journal of clinical oncology. Volume 12:Issue 4(2016)
• Page Start: 359
• Page End: 368
• Publication Date: 2016-07-25
• Subjects: cost–benefit analysis -- early detection of cancer -- gastrointestinal endoscopy -- Markov chains -- stomach neoplasm; Oncology -- Pacific Area -- Periodicals; Cancer -- Treatment -- Pacific Area -- Periodicals; Cancer -- Pacific Area -- Periodicals; Cancer -- Treatment -- Periodicals; 616.9940095
• DOI: 10.1111/ajco.12569
• Languages: English
• ISSNs: 1743-7555

Abstract

Abstract: Aim: To identify the optimal strategy for gastric cancer (GC) prevention by evaluating the cost‐effectiveness of esophagogastroduodenoscopy (EGD)‐based preventive strategies. Methods: We conducted a model‐based cost‐effectiveness analysis. Adopting a healthcare payer's perspective, Markov models simulated the clinical experience of the target population (Singaporean Chinese 50–69 years old) undergoing endoscopic screening, endoscopic surveillance and usual care of do‐nothing. The screening strategy examined the cohort every alternate year whereas the surveillance strategy provided annual EGD only to people with precancerous lesions. For each strategy, discounted lifetime costs ($) and quality adjusted life years (QALY) were estimated and compared to generate incremental cost‐effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis was conducted to identify influential parameters and quantify the impact of model uncertainties. Results: Annual EGD surveillance with an ICER of $34 200/QALY was deemed cost‐effective for GC prevention within the Singapore healthcare system. To inform implementation, the models identified six influential factors and their respective thresholds, namely discount rate (<4.20%), age of starting surveillance (>51.6 years), proportion of program cost in delivering endoscopy (<65%), cost of follow‐up EGD (<$484), utility of stage 1 GC patients (>0.72) and odds ratio of GC for high‐risk subjects (>3.93). The likelihood that surveillance is the most cost‐effective strategy is 69.5% accounting for model uncertainties. Conclusion: 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.