"Nuovo Regina Margherita" Hospital, Rome, Italy.
Helicobacter. 2010 Jun;15(3):221-6. doi: 10.1111/j.1523-5378.2010.00752.x.
Patients with intestinal metaplasia (IM) are at increased risk for gastric cancer. Endoscopic surveillance has been shown to anticipate cancer diagnosis in an earlier stage. Cost-effectiveness of endoscopic surveillance in IM patients is unknown. To assess the efficacy and cost-effectiveness of an yearly endoscopic surveillance in patients with IM.
A decision analysis model was constructed in order to compare a strategy of performing an EGD every year for a 10-year period (surveillance strategy) following a new diagnosis of IM to a policy of nonsurveillance in a simulated cohort of 10,000 American patients. A 1.8% 10-year cumulative incidence of gastric cancer in IM patients was estimated from the literature. Endoscopic surveillance was simulated to downstage the detected cancers by 58-84%. Costs of EGD and cancer care were estimated from Medicare reimbursement data. The main outcome measurement was the incremental cost-effectiveness ratio.
The number of EGDs required to detect one cancer and to prevent one gastric cancer-related death in the surveillance arm were 556 and 3738, respectively. The incremental cost-effectiveness ratio of endoscopic surveillance as compared to a nonsurveillance policy was $72,519 per life-year gained (5-95% percentiles Monte Carlo analysis: $54,843-$98,853). At sensitivity analysis, cancer incidence and the rate of downstaging were the most important variables.
According to our simulation, the relatively high risk of cancer in patients with IM and the substantial efficacy of endoscopic surveillance in reducing cancer-related mortality would support the cost-effectiveness of an endoscopic surveillance program in patients with IM. Further research is needed before implementing it in the clinical practice.
患有肠上皮化生（IM）的患者患胃癌的风险增加。内镜监测已被证明可在更早阶段预测癌症诊断。IM 患者内镜监测的成本效益尚不清楚。评估 IM 患者每年进行内镜监测的疗效和成本效益。
为了比较 IM 患者新诊断后 10 年内每年进行一次 EGD（监测策略）与不进行监测的策略，我们构建了一个决策分析模型，在模拟的 10000 名美国患者队列中进行。根据文献，估计 IM 患者 10 年内胃癌的累积发生率为 1.8%。模拟内镜监测可将检测到的癌症分期降低 58-84%。从医疗保险报销数据中估算 EGD 和癌症治疗的成本。主要结果测量是增量成本效益比。
在监测组中，发现 1 例癌症和预防 1 例胃癌相关死亡所需的 EGD 数量分别为 556 次和 3738 次。与不进行监测的策略相比，内镜监测的增量成本效益比为每获得 1 个生命年增加 72519 美元（5-95%百分位蒙特卡罗分析：54843-98853 美元）。在敏感性分析中，癌症发生率和分期降低率是最重要的变量。
根据我们的模拟，IM 患者癌症风险相对较高，内镜监测在降低癌症相关死亡率方面具有显著疗效，这支持了 IM 患者内镜监测计划的成本效益。在将其应用于临床实践之前，需要进一步研究。
