Morais Rui, Afonso João, Sousa Nuno, Sousa-Pinto Bernardo, Libânio Diogo, Marinho Bárbara, Sacramento Maria Luísa, Simplício Mariana, Faria-Ramos Isabel, Azevedo Luís, Marques Margarida, Silveira Helena, Gullo Irene, Carneiro Fátima, Santos-Antunes João, Macedo Guilherme
Department of Gastroenterology, Unidade Local de Saúde São João.
Faculty of Medicine.
Eur J Gastroenterol Hepatol. 2025 Jul 1;37(7):815-825. doi: 10.1097/MEG.0000000000002988. Epub 2025 Apr 29.
Patients with head and neck neoplasms (HNN) are at an increased risk of esophageal neoplasia (EN) and gastric neoplasia (GN). We aimed to assess the clinical impact and cost-utility of endoscopic screening in this population in the Western setting.
In this single-center study HNN patients eligible for curative treatment underwent screening esophagogastroduodenoscopy. We assessed the frequency, clinical, and pathological outcomes of EN and GN. The cost-effectiveness of an annual endoscopic screening for EN was evaluated from a societal perspective, using a Markov model and probabilistic sensitivity analysis. In addition, we performed a sensitivity analysis using data on the prevalence of detected EN lesions in the four largest previous Western studies on this topic.
Forty-six HNN patients met the inclusion criteria and underwent endoscopic screening. Six EN were detected in five patients (10.9%, 95% confidence interval: 1.9-19.9%). Additionally, five GN were detected in five patients. Most patients had early-stage EN or GN (90%) and were treated with endoscopic resection (80%). Endoscopic screening strategy had an incremental cost-effectiveness ratio of 39 357.8 €/quality-adjusted life years gained, being cost-effective at a willingness-to-pay threshold of two times the Portuguese gross domestic product per capita. In the sensitivity analysis, it remained cost-effective when considering the prevalence of EN reported in Germany, France, and Brazil.
An endoscopic screening program identified EN or GN in a fifth of HNN patients, most presenting at an early stage. The program implementation appears to be cost-effective in Portugal. These results may be applicable to other medium-to-high-income Western countries.
头颈部肿瘤（HNN）患者发生食管肿瘤（EN）和胃肿瘤（GN）的风险增加。我们旨在评估在西方背景下对该人群进行内镜筛查的临床影响和成本效益。
在这项单中心研究中，符合根治性治疗条件的HNN患者接受了食管胃十二指肠镜筛查。我们评估了EN和GN的发生频率、临床及病理结果。从社会角度，使用马尔可夫模型和概率敏感性分析评估了每年对EN进行内镜筛查的成本效益。此外，我们使用此前关于该主题的四项最大规模西方研究中检测到的EN病变患病率数据进行了敏感性分析。
46例HNN患者符合纳入标准并接受了内镜筛查。在5例患者中检测到6例EN（10.9%，95%置信区间：1.9 - 19.9%）。此外，在5例患者中检测到5例GN。大多数患者的EN或GN处于早期阶段（90%），并接受了内镜切除术（80%）。内镜筛查策略的增量成本效益比为每获得一个质量调整生命年39357.8欧元，在支付意愿阈值为葡萄牙人均国内生产总值两倍时具有成本效益。在敏感性分析中，考虑德国、法国和巴西报告的EN患病率时，该策略仍具有成本效益。
内镜筛查计划在五分之一的HNN患者中发现了EN或GN，大多数为早期病例。该计划在葡萄牙实施似乎具有成本效益。这些结果可能适用于其他中高收入西方国家。
