Cost-effectiveness of upper endoscopy for gastric cancer screening and surveillance in Western populations

Abstract

Background

Gastric cancer (GC) is the fourth leading cause of cancer-related deaths worldwide, with highest incidence rates in Asia. Endoscopic screening may facilitate early detection and reduces mortality, but its cost-effectiveness in Western populations, where GC is less prevalent, remains unclear. This review aimed to evaluate the cost-effectiveness of endoscopic screening and surveillance for GC in Western countries, considering regional epidemiologic and economic differences.

Methods

A systematic search of literature was conducted using PubMed and Embase databases, focusing on studies evaluating the cost-effectiveness of endoscopy in asymptomatic individuals or high-risk subgroups in Western populations. Studies reporting incremental cost-effectiveness ratios (ICERs) compared to no screening/surveillance were included.

Results

In total fourteen studies were evaluated. Six studies reported on endoscopic screening in the general population, three on screening in high-risk individuals, and seven on endoscopic surveillance, with varying intervals ranging from one-time procedures to procedures every ten years. Endoscopic screening was generally not cost-effective in Western populations. However, screening for high-risk subgroups, or combined with colonoscopy, following a positive fecal immunochemical test, improved cost-effectiveness. Endoscopic surveillance was consistently cost-effective, particularly for individuals with gastric intestinal metaplasia (GIM), showing the best cost-effectiveness at a three-to five-year interval, with ICERs ranging from €18,336 per Quality-Adjusted Life Year (QALY) in Europe to $87,000 per QALY in the USA. For higher-risk lesions, like dysplasia or incomplete GIM, shorter surveillance intervals may be beneficial.

Conclusion

While routine endoscopic screening may not be cost-effective in Western populations, surveillance for GIM every three to five years is economically sustainable. Higher-risk individuals with dysplasia or incomplete GIM may benefit from more frequent surveillance.