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Determining the cost‐effectiveness of endoscopic surveillance for gastric cancer in patients with precancerous lesions
Author(s) -
Wu Jin Tong,
Zhou Jun,
Naidoo Nasheen,
Yang Wen Yu,
Lin Xiao Cheng,
Wang Pei,
Ding Jin Qin,
Wu Chen Bin,
Zhou Hui Jun
Publication year - 2016
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12569
Subject(s) - medicine , esophagogastroduodenoscopy , health care , cost effectiveness , incremental cost effectiveness ratio , quality adjusted life year , cohort , population , emergency medicine , endoscopy , environmental health , surgery , risk analysis (engineering) , economics , economic growth
Abstract Aim To identify the optimal strategy for gastric cancer (GC) prevention by evaluating the cost‐effectiveness of esophagogastroduodenoscopy (EGD)‐based preventive strategies. Methods We conducted a model‐based cost‐effectiveness analysis. Adopting a healthcare payer's perspective, Markov models simulated the clinical experience of the target population (Singaporean Chinese 50–69 years old) undergoing endoscopic screening, endoscopic surveillance and usual care of do‐nothing. The screening strategy examined the cohort every alternate year whereas the surveillance strategy provided annual EGD only to people with precancerous lesions. For each strategy, discounted lifetime costs ($) and quality adjusted life years (QALY) were estimated and compared to generate incremental cost‐effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analysis was conducted to identify influential parameters and quantify the impact of model uncertainties. Results Annual EGD surveillance with an ICER of $34 200/QALY was deemed cost‐effective for GC prevention within the Singapore healthcare system. To inform implementation, the models identified six influential factors and their respective thresholds, namely discount rate (<4.20%), age of starting surveillance (>51.6 years), proportion of program cost in delivering endoscopy (<65%), cost of follow‐up EGD (<$484), utility of stage 1 GC patients (>0.72) and odds ratio of GC for high‐risk subjects (>3.93). The likelihood that surveillance is the most cost‐effective strategy is 69.5% accounting for model uncertainties. Conclusion Endoscopic surveillance of gastric premalignancies can be a cost‐effective strategy for GC prevention. Its implementation requires careful assessment on factors influencing the actual cost‐effectiveness.