Cost-effectiveness Analysis between Primary and Secondary Preventive Strategies for Gastric Cancer

Abstract

Objective: The present study is done to assess the relative cost-effectiveness, optimal initial age, and interscreening interval between primary and secondary prevention strategies for gastric cancer. Methods: Base-case estimates, including variables of natural history, efficacy of intervention, and relevant cost, were derived from two preventive programs targeting a highrisk population. Cost-effectiveness was compared between chemoprevention with 13 C urea breath testing followed by Helicobacter pylori (H. pylori) eradication and high-risk surveillance based on serum pepsinogen measurement and confirmed by endoscopy. The main outcome measure was cost per life-year gained with a 3% annual discount rate. Results: The incremental cost-effectiveness ratio (ICER) for once-only chemoprevention at age 30 years versus no screening was U.S. $17,044 per life-year gained. Eradication of H. pylori at later age or with a periodic scheme yielded a less favorable result. Annual high-risk screening at age of 50 years versus no screening resulted in an ICER of U.S. $29,741 per life-year gained. The ICERs of surveillance did not substantially vary with different initial ages or interscreening intervals. Chemoprevention could be dominated by high-risk surveillance when the initial age was older than 44 years. Otherwise, chemoprevention was more costeffective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative costeffectiveness was most sensitive to the infection rate of H. pylori and proportion of early gastric cancer in all detectable cases. Conclusions: Early H. pylori eradication once in lifetime seems more cost-effective than surveillance strategy. However, the choice is still subject to the risk of infection, detectability of early gastric cancer, and timing of intervention. (Cancer Epidemiol Biomarkers Prev 2007;16(5):875 -85)

Serum pepsinogen levels and their infl uencing factors: A population-based study in 6990 Chinese from North China

“…When it came to the atrophic lesion from the non-atrophic lesion, both PGⅠand PG Ⅱ levels had a trend to go down, suggesting that the PG Ⅰ/Ⅱ ratio reflects the development of atrophic lesion on gastric membranes better than either PGⅠor PGⅡ alone. The PGⅠ/Ⅱ values for atrophic gastritis were significantly lower than those for NOR and non-atrophic lesions, while there was no difference among these atrophic lesions, suggesting that the PGⅠ/Ⅱ ratio is an effective parameter for screening individuals at high risk of GC [9,[24][25][26][27] . We obtained the best cut-off points of the PG Ⅰ/Ⅱ ratio for detecting GC and its precursors by ROC curve with a sensitivity of 53.2% and a specialty of 67.5%, which can be used for further investigation as a screening tool in the first period.…”

Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)

“…Most of these studies compared strategies of screening for and treating H. pylori versus no screening from the public healthcare provider's perspective, used estimates from systematic reviews of the literature, and conducted sensitivity analyses with results that were consistent in most strategies. Despite involving populations with very different gastric cancer risks and also the use of diverse models, all studies concluded that the screening option is cost-effective compared with no screening [258][259][260][261][262][263][264][265][266][267][268][269][270].…”

Understanding Microbe-Induced Cancers

“…Numerous opportunities exist for eradicating H. pylori (e.g., with a relatively short course of antibiotics) during the several-decade-long pathogenesis of H. pylori-induced gastric cancer. Eradication on a mass basis, too early, and without good biomarkers, however, may have a high cost [e.g., increased risks of childhood asthma (56) and diseases of the esophagus and gastroesophageal junction (9,57)] in relation to the cancer prevention benefits that are realized decades later (58). The nonspecific effects of antibiotics also highlight the advantage of specificity that vaccines (such as the HPV and hepatitis B vaccines) can have.…”