Targeted, combined gastric cancer screening cost-effective, study finds
A modeling study identified the ages at which esophagogastroduodenoscopy screening for gastric cancer becomes cost-effective in various high-risk groups and found that it might be cost-effective for the general U.S. population if coupled with colonoscopy screening.
Targeted screening in people at high risk for gastric cancer should be considered in the U.S., and combining upper and lower endoscopy may make one-time screening and risk-stratified surveillance feasible for the general population, a modeling study found.
Researchers created Markov models of the natural history of gastric cancer to compare stand-alone and bundled screening and surveillance strategies using esophagogastroduodenoscopy (EGD) in average-risk patients, as well as those risk-stratified based on family history, immigrant status, and race/ethnicity. The primary outcomes were total cost, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratios (ICERs). Secondary outcomes were gastric cancer incidence, mortality, and unadjusted life-years gained. Results were published Dec. 9 by Clinical Gastroenterology and Hepatology.
In patients with a family history of gastric cancer, EGD screening starting at age 55 years, with surveillance every five years if intestinal metaplasia is diagnosed, was cost-effective at an ICER of $76,200/QALY. Starting at age 50 years was cost-effective in Asian patients (ICER, $83,600/QALY) and starting at age 55 years was cost-effective in Black patients (ICER, $99,500/QALY), Hispanic patients (ICER, $78,700/QALY), those with a family history of gastric cancer (ICER, $76,200/QALY), and high-risk immigrants (ICER, $95,900/QALY). The study did not consider patients with multiple first-degree relatives with gastric cancer or those with multiple risk factors, the authors noted. Stand-alone EGD screening was not cost-effective in average-risk patients, but bundling endoscopy with colonoscopy at age 45 years with surveillance for intestinal metaplasia every five years was cost-effective (ICER, $87,000/QALY).
The study authors called for prospective studies to validate potential benefits of preventive interventions and cautioned that the model assumed 100% adherence to all recommended screening, surveillance, and therapeutic procedures, which may not reflect real-world behavior. In addition, the model focused on secondary prevention and did not evaluate primary prevention strategies such as Helicobacter pylori test-and-treat.
“Although we evaluated scenarios in a hypothetical U.S. population, our model could be used as a surrogate in other low-incidence countries,” the authors wrote. “We provide important insight on screening and surveillance regimens in the U.S. context that may help inform future public health policy among both average-risk and risk-stratified populations.”