Cost‐Utility Analysis of Endoscopic Surveillance of Patients with Gastric Premalignant Conditions

Areia, Miguel; Dinis-Ribeiro, Mário; Gonçalves, Francisco Rocha

doi:10.1111/hel.12150

Cited by 58 publications

(63 citation statements)

References 68 publications

(82 reference statements)

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“…As such, there is a point in the progression of the disease when a significant risk of cancer development remains despite H pylori eradication. It is at this point that secondary prevention (eg, endoscopic surveillance) programs may become cost-effective in reducing gastric cancer deaths 15, 17, 18 . Candidates who might be suitable for non-invasive, secondary prevention surveillance programs can be identified based on serum levels of pepsinogen, which can be used to determine their risk for gastric cancer (Figure 1).…”

Section: H Pylori-associated Gastric Cancermentioning

confidence: 99%

Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits

2015

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Helicobacter pylori infection contributes to development of diverse gastric and extra-gastric diseases. The infection is necessary but not sufficient for development of gastric adenocarcinoma. Its eradication would eliminate a major worldwide cause of cancer death, so there is much interest in identifying how, if, and when this can be accomplished. There are several mechanisms by which H pylori contributes to development of gastric cancer. Gastric adenocarcinoma is one of many cancers associated with inflammation, which is induced by H pylori infection, yet the bacteria also cause genetic and epigenetic changes that lead to genetic instability in gastric epithelial cells. H pylori eradication reduces both. However, many factors must be considered in determining whether treating this bacterial infection will prevent cancer or only reduce its risk—these must be considered in designing reliable and effective eradication therapies. Furthermore, H pylori infection has been proposed to provide some benefits, such as reducing the risks of obesity or childhood asthma, although there are no convincing data to support the benefits of H pylori infections.

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Section: H Pylori-associated Gastric Cancermentioning

confidence: 99%

Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits

2015

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“…is cross-sectional study of patients scheduled for an upper endoscopy procedure provided utilities and selfreported QoL data for a nationwide population with a validated questionnaire in a sample of patients embracing all stages of the carcinogenic cascade for gastric adenocarcinoma. ese results, although speci c to the studied population, might be relevant to further cost-utility studies in gastric cancer as a recent systematic review showed that utilities were relevant in several studies for the nal results of the economic analysis, namely QoL in diseased patients and also a er treatments for cancer [7,8].…”

Section: Discussionmentioning

confidence: 93%

“…To the best of our knowledge this study is the first providing utilities for all stages of the gastric cancer cascade using a single health utilities measurement instrument. e study provides very useful information for authors conducting cost-utility analysis by incorporating utilities in their Markov models [8].…”

Section: Discussionmentioning

confidence: 99%

“…Also, models tend to use utilities reported in other studies, usually conducted in countries di erent from the population in the model, where health valuations might have given di erent results [7]. Utilities obtained in a population with a single questionnaire could be very suitable for conducting cost-utility analysis on the gastric cancer problem since they would provide comparative utilities for all stages of the gastric cancer cascade from an asymptomatic population to gastric cancer patients [8].…”

Section: Introductionmentioning

confidence: 99%

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Health-related Quality of Life and Utilities in Gastric Premalignant Conditions and Malignant Lesions: a Multicentre Study in a High Prevalence Country

Areia

Alves

Brito

et al. 2014

JGLD

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The health-related QoL utilities of patients with premalignant conditions are similar to those without gastric diseases whereas patients with present cancer show decreased utilities. Moreover, women had consistently lower utilities than men. These results confirm that the use of a single standardized instrument such as the EQ-5D-5L for all stages of the gastric carcinogenesis cascade is feasible and that it captures differences between conditions and gender dissimilarities, being relevant information for authors pretending to conduct further cost-utility analysis.

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“…In addition to "random" biopsies according to the updated Sydney protocol, also targeted samples from visible lesions should be taken to increase the diagnostic yield [142]. Although the strategy of 3-yearly endoscopic surveillance seems to be successful and cost effective also in a European setting, further prospective studies are required to deliver definite proof of its benefit [143][144][145]. The main issue remains the primary identification of patients who should undergo endoscopic surveillance.…”

Section: Secondary Preventionmentioning

confidence: 99%

The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract

Bornschein

Bird‐Lieberman

Malfertheiner

2019

Dig Dis

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While the primary risk factor for oesophageal adenocarcinoma (OAC) and its precursor lesion Barrett’s oesophagus (BO) is gastro-oesophageal reflux, the infection with Helicobacter pylori (H. pylori) is the dominant risk factor for gastric cancer. Reduction of reflux by dietary measures and proton pump inhibitors has some merits in OAC prevention, and the chemopreventive effect of Aspirin and statins is being widely investigated; however, improved outcome in OAC occurs primarily as the result of secondary prevention. Early detection of neoplastic lesions in Barrett’s metaplasia can be achieved by surveillance endoscopies. Novel endoscopic imaging modalities carry similar importance as the endoscopic treatment techniques as without detection of early lesions, therapy cannot be applied. Minimally invasive approaches are currently being investigated to identify patients with BO who are at particular risk of neoplastic progression. While dietary factors also play an important role in the prevention of gastric cancer and chemoprevention seems to be promising, the most beneficial effect has been shown for the eradication of H. pylori infection, which results in at least a one third reduction of gastric cancer risk. This effect can be further improved if the eradication takes place prior to the development of pre-neoplastic gastric conditions such as mucosal atrophy or intestinal metaplasia (IM). The definition of the “point of no return”, after which eradication is less effective, is of high importance, although H. pylori eradication can still be beneficial even at more advance stages of mucosal changes. For this reason, patients with advanced atrophy and IM should undergo endoscopic surveillance in the same way as patients with BO. There is also need for development of non-invasive tests to identify patients at high risk of progression to gastric cancer to improve outcome of these surveillance approaches.

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Cost‐Utility Analysis of Endoscopic Surveillance of Patients with Gastric Premalignant Conditions

Abstract: Endoscopic surveillance every 3 years of patients with premalignant conditions is cost-effective.

Cited by 58 publications

References 68 publications

Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits

Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits

Health-related Quality of Life and Utilities in Gastric Premalignant Conditions and Malignant Lesions: a Multicentre Study in a High Prevalence Country

The Rationale and Efficacy of Primary and Secondary Prevention in Adenocarcinomas of the Upper Gastrointestinal Tract

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