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Cost Effectiveness of Gastric Cancer Screening According to Race and Ethnicity.

Saumoy M, Schneider Y, Shen N, Kahaleh M, Sharaiha RZ, Shah SC
Gastroenterology. 2018 155 (3): 648-660

PMID: 29778607 · DOI:10.1053/j.gastro.2018.05.026

BACKGROUND & AIMS - There are marked racial and ethnic differences in non-cardia gastric cancer prevalence within the United States. Although gastric cancer screening is recommended in some regions of high prevalence, screening is not routinely performed in the United States. Our objective was to determine whether selected non-cardia gastric cancer screening for high-risk races and ethnicities within the United States is cost effective.

METHODS - We developed a decision analytic Markov model with the base case of a 50-year-old person of non-Hispanic white, non-Hispanic black, Hispanic, or Asian race or ethnicity. The cost effectiveness of a no-screening strategy (current standard) for non-cardia gastric cancer was compared with that of 2 endoscopic screening modalities initiated at the time of screening colonoscopy for colorectal cancer: upper esophagogastroduodenoscopy with biopsy examinations and continued surveillance only if intestinal metaplasia or more severe pathology is identified or esophagogastroduodenoscopy with biopsy examinations continued every 2 years even in the absence of identified pathology. We used prevalence rates, transition probabilities, costs, and quality-adjusted life years (QALYs) from publications and public data sources. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay threshold of $100,000/QALY.

RESULTS - Compared with biennial and no screening, screening esophagogastroduodenoscopy with continued surveillance only when indicated was cost effective for non-Hispanic blacks ($80,278/QALY), Hispanics ($76,070/QALY), and Asians ($71,451/QALY), but not for non-Hispanic whites ($122,428/QALY). The model was sensitive to intestinal metaplasia prevalence, transition rates from intestinal metaplasia to dysplasia to local and regional cancer, cost of endoscopy, and cost of resection (endoscopic or surgical).

CONCLUSIONS - Based on a decision analytic Markov model, endoscopic non-cardia gastric cancer screening for high-risk races and ethnicities could be cost effective in the United States.

Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

MeSH Terms (17)

African Americans Continental Population Groups Cost-Benefit Analysis Early Detection of Cancer Ethnic Groups European Continental Ancestry Group Female Gastroscopy Hispanic Americans Humans Male Markov Chains Mass Screening Middle Aged Quality-Adjusted Life Years Stomach Neoplasms United States

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