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Endoscopic screening for gastric cancer.
Yock Young Dan1, J B Y So, Khay Guan Yeoh
1Department of Gastroenterology and Hepatology, National University Hospital, Singapore.
Summary
Targeted endoscopic screening for stomach cancer in moderate to high-risk populations, particularly Chinese men aged 50-70, is cost-effective. This strategy can prevent deaths and improve life years, making it a valuable public health approach.
Area of Science:
- Medical Economics
- Gastroenterology
- Oncology
Background:
- Population endoscopic screening for gastric cancer is generally not cost-effective, except in high-prevalence areas like Japan.
- Lack of screening leads to advanced disease presentation and poor patient prognosis.
- This study aimed to assess cost-effectiveness in intermediate-risk populations and identify high-risk groups benefiting from screening.
Purpose of the Study:
- To determine the cost-effectiveness of endoscopic screening for stomach cancer in an intermediate-risk population.
- To identify specific high-risk subgroups that would benefit most from a targeted screening strategy.
- To analyze the economic impact of a 2-yearly endoscopic screening program versus no screening.
Main Methods:
- A Markov Model was employed for cost-effectiveness analysis.
- Simulations were conducted on the Singaporean population (intermediate-risk) and various high-risk subgroups.
- Data were systematically gathered from published studies (1980-2004) via PubMed search.
Main Results:
- Screening high-risk Chinese men (50-70 years) is highly cost-effective, yielding $26,836 per quality-adjusted life year (QALY) gained.
- A cohort of 199,000 individuals screened would prevent 743 stomach cancer deaths and save 8234 life years.
- The cost to avert one cancer death was calculated at $247,600, with sensitivity analysis highlighting cancer incidence and screening costs as key factors.
Conclusions:
- Endoscopic screening for stomach cancer is cost-effective in moderate to high-risk population subgroups.
- The findings support the exploration and implementation of targeted screening strategies for stomach cancer.
- This approach offers a viable method to reduce mortality and improve outcomes in at-risk individuals.