Lansdorp-Vogelaar I, Meester RGS, Laszkowskab M, Alarid-Escudero F, Ward Z, Yeh J. Cost-effectiveness of prevention and early detection of gastric cancer in western countries. Best Practice & Research Clinical Gastroenterology, 2021;50–51(101735):1-8.
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Abstract
Background
Gastric cancer (GC) is a significant global health problem, with Helicobacter pylori infection estimated to be responsible for 89% of non-cardiac GC cases, or 78% of all GC cases. The International Agency for Research on Cancer has called for Helicobacter pylori test-and-treat strategies in countries with high rates of GC. However, for countries with low rates of GC, such as most Western countries, the balance between benefits, harms and costs of screening is less clear-cut. GC is a disease with a well-characterized precancerous process, providing the basis for primary and secondary prevention efforts. However, rigorous data assessing the impact of such interventions in Western countries are lacking. In the absence of clinical trials, modelling offers a unique approach to evaluate the potential impact of various screening and surveillance interventions. In this paper, we provide an overview of modelling studies evaluating the cost-effectiveness of GC screening and surveillance in Western countries.
Summary
H. pylori test-and-treat is a potentially cost-effective strategy to reduce GC mortality in Western countries. However, it is too early for widespread implementation until more is known about the potential adverse impact of widespread antibiotic use on ABR. Until that time, a more limited approach targeting only those at higher risk, such as recent immigrants from endemic countries or smokers, could be considered. Pepsinogen testing could be a potential alternative to H. pylori test-and-treat, addressing the concerns of ABR. However, more evidence on its effectiveness is needed and pepsinogen testing may not have the same level of ancillary benefits from preventing peptic ulcers and dyspepsia as H. pylori test-and-treat strategies have. Research to date finds that screening the general population with upper endoscopy is not cost-effective, while the cost-effectiveness of upper endoscopy for surveillance of patients with intestinal metaplasia is uncertain but may be effective in high risk groups. To allow for a better evaluation of harms, costs and benefits of surveillance, it is important that patients with intestinal metaplasia are included in large well-characterized cohorts for future evaluation.