Endoscopic screening for gastric cancer
Endoscopic screening for gastric cancer
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DOI：
10.1016/j.cgh.2006.03.025
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发表时间：
2006-06-01
影响因子：
12.6
通讯作者：
Yeoh, Khay Guan
中科院分区：
文献类型：
--
作者：
Dan, Yock Young;So, J. B. Y.;Yeoh, Khay Guan
背景与目的：除日本外，胃癌的人群内镜筛查通常被认为不具有成本效益，因为日本的胃癌患病率非常高。然而，在缺乏筛查的情况下，患者病情已处于晚期，预后较差。我们进行了成本效用分析，以确定在中等风险人群中进行胃癌内镜筛查是否具有成本效益，并更好地确定人群中哪些高风险人群将从这种策略中受益。方法：利用马尔可夫模型进行成本效益分析。对新加坡（中等风险）人群和各种高风险亚组进行了模拟。对两年一次的内窥镜大规模筛查计划与不进行筛查进行了比较。数据来源摘自 1980 年至 2004 年发表的相关研究，通过系统的 PUBMED 搜索确定。主要结果指标是避免胃癌引起的死亡、挽救每条生命的成本以及以每质量调整生命年 (QALY) 节省的成本表示的增量成本效益比。结果：对50-70岁中国男性高危人群（年龄标准化率，25.9/10万）进行筛查具有很高的成本效益，每个QALY的成本效益为26,836美元。对这 199,000 名受试者进行筛查可预防 743 例胃癌死亡，并挽救 8234 绝对生命年。避免癌症死亡的费用为美国 247,600 美元。成本效益对胃癌的发病率和筛查内窥镜检查的成本最敏感。结论：在中高危人群亚组中进行胃癌筛查具有成本效益。应探索胃癌的针对性筛查策略。
Background & Aims: Population endoscopic screening for gastric cancer is generally deemed not to be cost-effective except in Japan, where its prevalence is very high. However, in the absence of screening, patients present with advanced disease, and prognosis is poor. We conducted a cost utility analysis to determine whether endoscopic screening for stomach cancer in intermediate-risk population would be cost-effective and to better define the high-risk groups in the population who would benefit from such strategy. Methods: Cost-effectiveness analysis was performed by using a Markov Model. Simulation was performed on Singapore (intermediate-risk) population and various high-risk subgroups. Comparison was made between 2-yearly endoscopic mass screening program versus no screening. Data sources were extracted from relevant studies published from 1980-2004 identified via systematic PUBMED search. Main outcome measures were deaths caused by stomach cancer averted, cost per life saved, and incremental cost-effectiveness ratio expressed as cost per quality-adjusted life year (QALY) saved. Results: Screening of high-risk group of Chinese men (age-standardized rate, 25.9/100,000) from 50-70 years old is highly cost-effective, with cost benefit of United States $26,836 Per QALY. Screening this cohort of 199,000 subjects prevents 743 stomach cancer deaths and saves 8234 absolute life years. Cost of averting I cancer death is United States $247,600. Cost-effectiveness was most sensitive to incidence of stomach cancer and cost of screening endoscopy. Conclusions: Screening of stomach cancer in moderate to high-risk population subgroups is cost-effective. Targeted screening strategies for stomach cancer should be explored.