Division of Gastroenterology & Hepatology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, New York.
Division of Gastroenterology and Hepatology, Robert Wood Johnson School of Medicine, New Brunswick New Jersey.
Gastroenterology. 2018 Sep;155(3):648-660. doi: 10.1053/j.gastro.2018.05.026. Epub 2018 May 17.
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.
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.
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).
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.
在美国，非贲门胃癌的患病率存在明显的种族和民族差异。尽管在一些高发地区推荐进行胃癌筛查，但在美国并未常规进行筛查。我们的目的是确定在美国，针对高危种族和民族进行非贲门胃癌的选择性筛查是否具有成本效益。
我们开发了一个决策分析马尔可夫模型，以 50 岁的非西班牙裔白种人、非西班牙裔黑种人、西班牙裔或亚洲人种或族裔为基础病例。将无筛查策略（当前标准）与 2 种内镜筛查方法进行比较，这 2 种方法在筛查结直肠癌时同时进行：上消化道内镜检查和活检，如果发现肠上皮化生或更严重的病理，则继续监测；或即使没有发现病理，也每 2 年进行一次上消化道内镜检查和活检。我们使用了来自出版物和公共数据源的患病率、转移概率、成本和质量调整生命年（QALY）。结果以增量成本效益比报告，愿意支付的阈值为 100,000 美元/QALY。
与每 2 年筛查和不筛查相比，仅在有指征时进行内镜下上消化道检查和继续监测对非西班牙裔黑种人（80,278 美元/QALY）、西班牙裔（76,070 美元/QALY）和亚裔（71,451 美元/QALY）具有成本效益，但对非西班牙裔白种人（122,428 美元/QALY）则不具有成本效益。该模型对肠上皮化生的患病率、从肠上皮化生到异型增生到局部和区域癌症的转移率、内镜检查的成本以及内镜或手术切除的成本敏感。
基于决策分析马尔可夫模型，针对高危种族和民族进行内镜下非贲门胃癌筛查在美国可能具有成本效益。
