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 high-risk 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 cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness 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.
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 high-risk 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 cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness 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.
Authors: Hoo-Yeon Lee; Sun Mi Lim; Mi Ah Han; Jae Kwan Jun; Kui Son Choi; Myung-Il Hahm; Eun-Cheol Park Journal: World J Gastroenterol Date: 2011-09-28 Impact factor: 5.742
Authors: M Dinis-Ribeiro; M Areia; A C de Vries; R Marcos-Pinto; M Monteiro-Soares; A O'Connor; C Pereira; P Pimentel-Nunes; R Correia; A Ensari; J M Dumonceau; J C Machado; G Macedo; P Malfertheiner; T Matysiak-Budnik; F Megraud; K Miki; C O'Morain; R M Peek; T Ponchon; A Ristimaki; B Rembacken; F Carneiro; E J Kuipers Journal: Virchows Arch Date: 2011-12-22 Impact factor: 4.064
Authors: M Dinis-Ribeiro; M Areia; A C de Vries; R Marcos-Pinto; M Monteiro-Soares; A O'Connor; C Pereira; P Pimentel-Nunes; R Correia; A Ensari; J M Dumonceau; J C Machado; G Macedo; P Malfertheiner; T Matysiak-Budnik; F Megraud; K Miki; C O'Morain; R M Peek; T Ponchon; A Ristimaki; B Rembacken; F Carneiro; E J Kuipers Journal: Endoscopy Date: 2011-12-23 Impact factor: 10.093
Authors: Matthew Banks; David Graham; Marnix Jansen; Takuji Gotoda; Sergio Coda; Massimiliano di Pietro; Noriya Uedo; Pradeep Bhandari; D Mark Pritchard; Ernst J Kuipers; Manuel Rodriguez-Justo; Marco R Novelli; Krish Ragunath; Neil Shepherd; Mario Dinis-Ribeiro Journal: Gut Date: 2019-07-05 Impact factor: 23.059
Authors: Douglas R Morgan; Javier Torres; Rachael Sexton; Rolando Herrero; Eduardo Salazar-Martínez; E Robert Greenberg; Luis Eduardo Bravo; Ricardo L Dominguez; Catterina Ferreccio; Eduardo C Lazcano-Ponce; Maria Mercedes Meza-Montenegro; Edgar M Peña; Rodolfo Peña; Pelayo Correa; María Elena Martínez; William D Chey; Manuel Valdivieso; Garnet L Anderson; Gary E Goodman; John J Crowley; Laurence H Baker Journal: JAMA Date: 2013-02-13 Impact factor: 56.272