Decision model analyses of upper endoscopy for gastric cancer screening and preneoplasia surveillance: a systematic review

Abstract

Aims: Gastric cancer (GC) is the third leading cause of cancer death worldwide, but the burden of disease is not distributed evenly. GC screening routinely occurs in some high-incidence regions/countries and is generally cost-effective, which is attributed largely to the associated GC mortality reduction. In regions of low–intermediate incidence, less is known about the outcomes of GC screening and gastric precancer surveillance, including cost-effectiveness, since there are no comparative clinical studies. Decision analytic studies are informative in such instances where logistical limitations preclude “gold standard” study designs. We therefore aimed to conduct a systematic review of decision model analyses focused on endoscopic GC screening or precancer surveillance. Methods: We identified decision model analyses, including cost effectiveness and cost utility studies, of GC screening or preneoplasia surveillance. At minimum, articles were evaluated for: study country; analytic design; population and health states; time horizon; model assumptions; outcomes; threshold value(s) for “cost-effective” determination; and sensitivity analyses. Quality appraisal was performed using a modified Drummond’s analytic scoring system. Data sources were PubMed, Web of Science, Embase, and the Cochrane Library Results: We identified 17 studies (8 screening, 4 surveillance, and 5 screening and surveillance) that met full inclusion criteria. Endoscopic screening in countries of high GC incidence was cost-effective across all studies; targeted screening of high-risk populations within otherwise low-intermediate incidence countries was also generally cost-effective. Surveillance of gastric precancer, including atrophic gastritis or gastric intestinal metaplasia, was generally cost-effective. Most studies had high appraisal scores, with 4 (24%) studies achieving perfect scores on the Drummond scale. Conclusion: Decision model analyses offer a unique mechanism with which to efficiently explore the cost benefit of various prevention and early detection strategies. Based on this comprehensive systematic review, upper endoscopy for GC screening and gastric precancer surveillance might be cost-effective depending on the population and protocol. Focused efforts are especially needed not only to define the optimal approach, but also to define the populations within otherwise low-intermediate regions/countries who might benefit most.

Stomach cancer incidence and mortality in Greater Cuiabá, Mato Grosso, Brazil, 2000-2016

“…However, despite the scarcity of national studies on the subject, a systematic review suggests that endoscopy may be a cost-effective strategy for screening and surveillance of stomach cancer, depending on the population and protocol 23 .…”

Gastric Cancer Screening in Japan: A Narrative Review

“…Several cost-effectiveness analyses demonstrated that endoscopic surveillance is a cost-effective method to reduce gastric cancer mortality. A comprehensive systematic review showed that endoscopic screening is cost-effective in high-incidence countries, and that targeted endoscopic screening of high-risk populations is also generally cost-effective in low-intermediate incidence countries [ 86 ]. Recently, Kowada et al demonstrated that biennial endoscopy for patients with mild-to-moderate gastric mucosal atrophy and annual endoscopy for patients with severe gastric mucosal atrophy were the most cost-effective measures after H. pylori eradication [ 87 ].…”

Sharing With Patients the Uncertainties Regarding the Management of Dyspepsia

“…Endoscopic screening of individuals younger than 50 years in high incidence countries and of populations in low-intermediate incidence countries was not. Most decision models assumed that, compared with no screening, endoscopic screening reduced gastric cancer mortality ( 22 ).…”