Areia Miguel, Spaander Manon Cw, Kuipers Ernst J, Dinis-Ribeiro Mário
Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal.
United European Gastroenterol J. 2018 Mar;6(2):192-202. doi: 10.1177/2050640617722902. Epub 2017 Jul 18.
Endoscopic screening for gastric cancer is debatable in countries with an intermediate risk.
The objective of this article is to determine the cost-utility of screening strategies for gastric cancer in a European country.
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).
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.
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.
在胃癌风险中等的国家，内镜筛查胃癌存在争议。
本文旨在确定欧洲某国胃癌筛查策略的成本效益。
我们使用马尔可夫模型进行成本效益分析，比较三种筛查策略与不筛查的情况：单独上消化道内镜检查、粪便潜血试验阳性后内镜检查联合结直肠癌筛查结肠镜检查或胃蛋白酶原血清学筛查。临床数据来自系统评价，成本来自已发表的国家数据，效用以质量调整生命年（QALY）表示。主要结局是增量成本效益比（ICER）。进行了确定性和概率性敏感性分析。阈值设定为37,000欧元（2016年价格）。
上消化道内镜检查联合筛查结肠镜检查（每10年或5年一次）的ICER分别为每QALY 15,407欧元和每QALY 30,908欧元，单独内镜筛查（每5年一次）的ICER为每QALY 70,693欧元，胃蛋白酶原筛查的ICER为每QALY 143,344欧元。敏感性分析显示，只有内镜检查成本<75欧元、每位患者仅进行三次内镜检查或胃癌风险>25/100,000时，单独内镜筛查才具有成本效益。
在胃癌风险≥每10万例中有10例的国家，如果内镜胃癌筛查与筛查结肠镜检查相结合，在欧洲可能具有成本效益。
