Cost Effectiveness of Gastric Cancer Screening According to Race and Ethnicity
Cost Effectiveness of Gastric Cancer Screening According to Race and Ethnicity
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DOI：
10.1053/j.gastro.2018.05.026
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发表时间：
2018-09-01
期刊：
影响因子：
29.4
通讯作者：
Shah, Shailja C.
中科院分区：
文献类型：
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作者：
Saumoy, Monica;Schneider, Yecheskel;Shah, Shailja C.
背景与目的：在美国，非贲门胃癌的患病率存在明显的种族和民族差异。虽然胃癌筛查建议在一些高患病率的地区，筛查在美国不是常规进行。我们的目的是确定在美国对高风险种族和民族进行非贲门胃癌筛查是否具有成本效益。方法：我们开发了一个决策分析马尔可夫模型的基础情况下，一个50岁的人的非西班牙裔白色，非西班牙裔黑人，西班牙裔，或亚洲种族或民族。无筛查策略的成本效益（现行标准）与结肠镜检查结直肠癌筛查时启动的2种内镜筛查模式进行比较：仅在发现肠上皮化生或更严重的病理时，进行上部食管胃镜检查和活检检查并继续监测，或每2年进行一次食管胃镜检查和活检检查，即使在没有确定的病理学。我们使用了来自出版物和公共数据来源的患病率、转移概率、成本和质量调整生命年（QHMS）。结果测量报告增量成本效益比，支付意愿阈值为100，000美元/QALY。研究结果：与两年一次和不进行筛查相比，仅在有指征时进行筛查性食管胃镜检查和持续监测对于非西班牙裔黑人（80，278美元/QALY）、西班牙裔（76，070美元/QALY）和亚洲人（71，451美元/QALY）具有成本效益，但对于非西班牙裔白人（122，428美元/QALY）则无成本效益。该模型对肠上皮化生的患病率、肠上皮化生向异型增生向局部和区域性癌症的转变率、内镜检查的费用和切除术（内镜或手术）的费用敏感。结论：基于决策分析马尔可夫模型，内镜下非贲门胃癌筛查的高风险种族和民族可能是成本效益在美国。
BACKGROUND & AIMS: There are marked racial and ethnic differences in non-cardia gastric cancer prevalence within the United States. Although gastric cancer screening is recommended in some regions of high prevalence, screening is not routinely performed in the United States. Our objective was to determine whether selected non-cardia gastric cancer screening for high-risk races and ethnicities within the United States is cost effective. METHODS: We developed a decision analytic Markov model with the base case of a 50-year-old person of non-Hispanic white, non-Hispanic black, Hispanic, or Asian race or ethnicity. The cost effectiveness of a no-screening strategy (current standard) for non-cardia gastric cancer was compared with that of 2 endoscopic screening modalities initiated at the time of screening colonoscopy for colorectal cancer: upper esophagogastroduodenoscopy with biopsy examinations and continued surveillance only if intestinal metaplasia or more severe pathology is identified or esophagogastroduodenoscopy with biopsy examinations continued every 2 years even in the absence of identified pathology. We used prevalence rates, transition probabilities, costs, and quality-adjusted life years (QALYs) from publications and public data sources. Outcome measures were reported in incremental cost-effectiveness ratios, with a willingness-to-pay threshold of $100,000/QALY. RESULTS: Compared with biennial and no screening, screening esophagogastroduodenoscopy with continued surveillance only when indicated was cost effective for non-Hispanic blacks ($80,278/QALY), Hispanics ($76,070/QALY), and Asians ($71,451/QALY), but not for non-Hispanic whites ($122,428/QALY). The model was sensitive to intestinal metaplasia prevalence, transition rates from intestinal metaplasia to dysplasia to local and regional cancer, cost of endoscopy, and cost of resection (endoscopic or surgical). CONCLUSIONS: Based on a decision analytic Markov model, endoscopic non-cardia gastric cancer screening for high-risk races and ethnicities could be cost effective in the United States.