Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis.
Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis.
复制标题
DOI：
10.1136/gutjnl-2014-308588
复制
发表时间：
2016-04
期刊：
影响因子：
24.5
通讯作者：
Goldie SJ
中科院分区：
文献类型：
--
作者：
Yeh JM;Hur C;Ward Z;Schrag D;Goldie SJ
评估基于新生物标志物和内镜技术的非贲门胃腺癌（NCGA）筛查策略的成本-效果。我们使用消化道型NCGA显微模拟模型，评价了美国男性的以下一次性筛查策略：1）血清胃蛋白酶原检测胃萎缩（阳性筛查结果的内镜随访），2）内镜筛查检测异型增生和无症状癌症（检测到的病变的内镜粘膜切除术（EMR）治疗），3）幽门螺杆菌筛查和治疗。筛查性能、治疗效果、癌症和成本数据基于已发表的文献和数据库。亚组包括当前吸烟者、既往吸烟者和从不吸烟者。结果包括终生癌症风险和增量成本效果比（ICER），表示为每质量调整生命年（QALY）的成本。在50岁时对一般人群进行筛查，血清胃蛋白酶原筛查可使终生胃肠道型NCGA风险（0.24%）降低26.4%，内镜检查和EMR可降低21.2%，H.幽门螺杆菌筛查/治疗。针对当前吸烟者的终生风险（0.35%）分别降低了30.8%、25.5%和0.1%。对于所有亚组，血清胃蛋白酶原筛查比所有其他策略更有效，更具成本效益，尽管其ICER从76，000美元/QALY（当前吸烟者）到105，400美元/QALY（一般人群）不等。结果对H. pylori患病率、筛查年龄和血清胃蛋白酶原检测敏感性。概率敏感性分析发现，在100，000美元/QALY的支付意愿阈值下，目前吸烟者首选血清胃蛋白酶原筛查的概率为0.97。虽然不适合一般人群，但针对高危吸烟者进行血清胃蛋白酶原筛查可能是降低肺型NCGA死亡率的一种具有成本效益的策略。
To estimate the cost-effectiveness of noncardia gastric adenocarcinoma (NCGA) screening strategies based on new biomarker and endoscopic technologies. Using an intestinal-type NCGA microsimulation model, we evaluated the following one-time screening strategies for US men: 1) serum pepsinogen to detect gastric atrophy (with endoscopic follow-up of positive screen results), 2) endoscopic screening to detect dysplasia and asymptomatic cancer (with endoscopic mucosal resection (EMR) treatment for detected lesions), and 3) Helicobacter pylori screening and treatment. Screening performance, treatment effectiveness, cancer and cost data were based on published literature and databases. Subgroups included current, former and never smokers. Outcomes included lifetime cancer risk and incremental cost-effectiveness ratios (ICERs), expressed as cost per quality-adjusted-life-year (QALY) gained. Screening the general population at age 50 reduced the lifetime intestinal-type NCGA risk (0.24%) by 26.4% with serum pepsinogen screening, 21.2% with endoscopy and EMR, and 0.2% with H. pylori screening/treatment. Targeting current smokers reduced the lifetime risk (0.35%) by 30.8%, 25.5%, and 0.1%, respectively. For all subgroups, serum pepsinogen screening was more effective and more cost-effective than all other strategies, although its ICER varied from $76,000/QALY (current smokers) to $105,400/QALY (general population). Results were sensitive to H. pylori prevalence, screen age, and serum pepsinogen test sensitivity. Probabilistic sensitivity analysis found that at a $100,000/QALY willingness-to-pay threshold, the probability that serum pepsinogen screening was preferred was 0.97 for current smokers. Although not warranted for the general population, targeting high-risk smokers for serum pepsinogen screening may be a cost-effective strategy to reduce intestinal-type NCGA mortality.