在西方人群中，上胃镜用于胃癌筛查和监测的成本-效果

IF 3.2 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Best Practice & Research Clinical Gastroenterology Pub Date : 2025-03-01 DOI:10.1016/j.bpg.2025.101982

N.E.A. Kapteijn , D.T. Mülder , I. Lansdorp-Vogelaar

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引用次数: 0

摘要

胃癌（GC）是全球第四大癌症相关死亡原因，亚洲发病率最高。内窥镜筛查可能有助于早期发现并降低死亡率，但其在胃癌发病率较低的西方人群中的成本效益尚不清楚。考虑到地区流行病学和经济差异，本综述旨在评估西方国家内镜筛查和监测胃癌的成本效益。方法使用PubMed和Embase数据库系统检索文献，重点研究评估西方人群中无症状个体或高危亚群内窥镜检查的成本-效果。研究报告了与不进行筛查/监测相比的增量成本-效果比（ICERs）。结果共评价了14项研究。6项研究报道了普通人群的内窥镜筛查，3项研究报道了高危人群的内窥镜筛查，7项研究报道了内窥镜监测，时间间隔从一次到每十年一次不等。内窥镜筛查在西方人群中通常不具有成本效益。然而，在粪便免疫化学试验阳性后，对高危亚群进行筛查或联合结肠镜检查可提高成本效益。内镜监测始终具有成本效益，特别是对于胃肠道化生（GIM）患者，在三到五年的间隔内显示出最佳的成本效益，ICERs从欧洲的每个质量调整生命年（QALY） 18,336欧元到美国的每个QALY 87,000美元不等。对于高风险病变，如发育不良或不完全GIM，较短的监测间隔可能是有益的。结论：虽然常规内镜筛查在西方人群中可能不具有成本效益，但每3 - 5年进行GIM监测在经济上是可持续的。患有发育不良或不完全GIM的高风险个体可能受益于更频繁的监测。

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

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.

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来源期刊

Best Practice & Research Clinical Gastroenterology 医学-胃肠肝病学

CiteScore

5.50

自引率

0.00%

发文量

审稿时长

69 days

期刊介绍： Each topic-based issue of Best Practice & Research Clinical Gastroenterology will provide a comprehensive review of current clinical practice and thinking within the specialty of gastroenterology.