Cost-Utility Analysis of Endoscopic Surveillance of Patients with Gastric Premalignant Conditions
Cost-Utility Analysis of Endoscopic Surveillance of Patients with Gastric Premalignant Conditions
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DOI：
10.1111/hel.12150
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发表时间：
2014-12-01
期刊：
影响因子：
4.4
通讯作者：
Goncalves, Francisco Rocha
中科院分区：
文献类型：
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作者：
Areia, Miguel;Dinis-Ribeiro, Mario;Goncalves, Francisco Rocha
背景：广泛的胃癌前病变发展为癌症可能需要监测程序。最近的指南建议对这些患者进行3年一次的内镜随访。我们的目的是确定内镜下监测广泛胃癌前病变（如广泛萎缩或肠化生）患者的成本效用。材料和方法从葡萄牙的社会角度进行成本效用经济分析，使用马尔可夫模型比较两种策略：监督与不监督。临床数据收集自文献系统综述，费用收集自已发表的国家数据，社区效用收集自EuroQol问卷中关于质量调整生命年（QALY）的人口研究。人口从50岁开始，时间跨度为25年，为了成本和效果，使用了3%的年贴现率。主要结局是在确定和概率敏感性分析的基础情况下，3年内镜监测与无监测的增量成本-效果比（ICER）。次要结果是5年和10年内窥镜监测与无监测的ICER。结果镜下监测每3年的ICER为18,336欧元，低于采用的阈值36,575欧元，与建议的指导限值50,000美元相对应，该策略每5年或10年主导监测。在确定性分析中，内镜治疗的效用是相关的，而概率分析显示，在78%的病例中，该模型是具有成本效益的。结论每3年对恶性肿瘤前病变患者进行镜下监测是具有成本效益的。
BackgroundProgression of extensive gastric premalignant conditions to cancer might warrant surveillance programms. Recent guidelines suggest a 3-yearly endoscopic follow-up for these patients. Our aim was to determine the cost utility of endoscopic surveillance of patients with extensive gastric premalignant conditions such as extensive atrophy or intestinal metaplasia.Materials and MethodsA cost-utility economic analysis was performed from a societal perspective in Portugal using a Markov model to compare two strategies: surveillance versus no surveillance. Clinical data were collected from a systematic review of the literature, costs from published national data, and community utilities derived from a population study by the EuroQol questionnaire in terms of quality-adjusted life years (QALY). Population started at age 50, for a time horizon of 25years and an annual discount rate of 3% was used for cost and effectiveness. Primary outcome was the incremental cost-effectiveness ratio (ICER) of a 3-yearly endoscopic surveillance versus no surveillance for a base case scenario and in deterministic and probabilistic sensitivity analysis. Secondary outcomes were ICER of 5- and 10-yearly endoscopic surveillance versus no surveillance.ResultsEndoscopic surveillance every 3years provided an ICER of Euro 18,336, below the adopted threshold of Euro 36,575 which corresponds to the proposed guideline limit of USD 50,000 and this strategy dominated surveillance every 5 or 10years. Utilities for endoscopic treatment were relevant in deterministic analysis, while probabilistic analysis showed that in 78% of cases the model was cost-effective.ConclusionsEndoscopic surveillance every 3years of patients with premalignant conditions is cost-effective.