Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025
The Cost-Effectiveness of Gastric Cancer Screening and Surveillance Among Average-Risk and Risk-Stratified Populations.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Laszkowska Monika, Hahn Anne I, King Stephanie, Seguin Claudia L, Knudsen Amy B, Lim Francesca, Ferris Jennifer S, Prest Matthew, Agyekum Alice, Hur Chin, Zauber Ann G
Аннотация
BACKGROUND & AIMS: Guidelines cite certain risk factors for gastric cancer (GC) as an indication for surveillance of incidentally diagnosed gastric intestinal metaplasia (IM); however, guidance on risk thresholds for routine IM screening is lacking. Cost-saving options in average-risk populations, such as bundling endoscopy with colonoscopy for colorectal cancer screening, have not been directly explored. We aimed to assess effectiveness and cost-effectiveness of screening for GC among average-risk and risk-stratified populations.
METHODS: Markov models of the natural history of GC were developed to compare standalone and bundled screening and surveillance strategies with esophagogastroduodenoscopy (EGD) in average-risk individuals, and individuals risk-stratified based on family history of GC, immigrant status, and race/ethnicity. The primary outcomes were total cost, quality-adjusted life-years gained (QALYGs), and incremental cost-effectiveness ratios (ICERs). Secondary outcomes were GC incidence, mortality, and unadjusted life-years gained.
RESULTS: Screening EGD starting at age 50 with surveillance every 5 years if IM is diagnosed was cost-effective in Asian individuals (ICER, $83,600/QALYG), and starting at age 55 was cost-effective in Black individuals (ICER, $99,500/QALYG), Hispanic individuals (ICER, $78,700/QALYG), those with a family history of GC (ICER, $76,200/QALYG), and high-risk immigrants (ICER, $95,900/QALYG). Standalone EGD screening was not cost-effective in average-risk individuals, but bundling endoscopy with colonoscopy at age 45 with surveillance for IM every 5 years was cost-effective (ICER, $87,000/QALYG).
CONCLUSIONS: Targeted screening in high-risk individuals for GC should be considered in the United States. Combining upper and lower endoscopy may make one-time GC screening and risk-stratified surveillance feasible for the general population. Prospective studies are needed to validate potential benefits of preventative interventions.
METHODS: Markov models of the natural history of GC were developed to compare standalone and bundled screening and surveillance strategies with esophagogastroduodenoscopy (EGD) in average-risk individuals, and individuals risk-stratified based on family history of GC, immigrant status, and race/ethnicity. The primary outcomes were total cost, quality-adjusted life-years gained (QALYGs), and incremental cost-effectiveness ratios (ICERs). Secondary outcomes were GC incidence, mortality, and unadjusted life-years gained.
RESULTS: Screening EGD starting at age 50 with surveillance every 5 years if IM is diagnosed was cost-effective in Asian individuals (ICER, $83,600/QALYG), and starting at age 55 was cost-effective in Black individuals (ICER, $99,500/QALYG), Hispanic individuals (ICER, $78,700/QALYG), those with a family history of GC (ICER, $76,200/QALYG), and high-risk immigrants (ICER, $95,900/QALYG). Standalone EGD screening was not cost-effective in average-risk individuals, but bundling endoscopy with colonoscopy at age 45 with surveillance for IM every 5 years was cost-effective (ICER, $87,000/QALYG).
CONCLUSIONS: Targeted screening in high-risk individuals for GC should be considered in the United States. Combining upper and lower endoscopy may make one-time GC screening and risk-stratified surveillance feasible for the general population. Prospective studies are needed to validate potential benefits of preventative interventions.