Related Experiment Videos
Opportunistic Gastric Cancer Endoscopic Screening Integrated Into Population-Based Colorectal Cancer Screening: A
B Mourato1,2, P Pinto3, J Vieira3
1NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, LA-REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal.
Background:
Gastric cancer (GC) remains a major cause of cancer-related mortality worldwide, with prognosis and treatment costs strongly influenced by disease stage at diagnosis. Endoscopic GC screening has been proposed for intermediate-to-high-risk countries, although its economic feasibility remains uncertain. This study evaluated the costs associated with opportunistic GC screening integrated into a colorectal cancer screening programme and compared modeled early-stage management scenarios with the real-world costs of managing Stages II-IV disease.
Methods:
A retrospective cost-comparison study was conducted from the perspective of the Portuguese National Health Service. Screening costs were derived from 377 fecal immunochemical testing-positive individuals undergoing one-time opportunistic esophagogastroduodenoscopy (EGD) during colonoscopy within the organized colorectal cancer screening programme, and treatment costs from a retrospective cohort of 222 patients with gastric adenocarcinoma. Direct medical costs were analyzed according to disease stage and compared with two modeled early-stage management scenarios.
Results:
Gastric precancerous conditions were identified in 46.9% of screened individuals, and gastric adenocarcinoma was detected in 0.8% (3/377). The estimated screening cost was €17,249 per cancer detected. Mean treatment and follow-up costs per patient were €32,140 for Stage II disease, €33,073 for Stage III disease, and €19,287 for Stage IV disease. The estimated cumulative cost of screening followed by ESD was €27,624, whereas screening followed by surgical treatment of Stage I disease was estimated at €44,493.
Conclusions:
GC management is associated with substantial healthcare expenditure. The potential economic value of opportunistic GC screening is likely to depend on the detection of lesions amenable to endoscopic treatment.
Trail Registration:
NCT07522320.