Cost-effectiveness of endoscopic surveillance of gastric ulcers to improve survival.
BACKGROUND
Endoscopic surveillance of presumed-benign gastric ulcers may detect missed malignancy, but its impact on long-term outcomes is uncertain.


OBJECTIVE
To estimate the clinical benefits and cost-effectiveness of follow-up surveillance.


METHODS
State-transition model.


METHODS
To simulate the clinical course of presumed-benign gastric ulcers, we estimated prevalence and incidence of undetected gastric cancer, surveillance effectiveness, stage-specific disease mortality rates, and costs from clinical studies and databases.


METHODS
This study involved 60-year-old men diagnosed with presumed-benign gastric ulcers.


METHODS
Follow-up endoscopic surveillance.


METHODS
Lifetime gastric cancer risk, life expectancy, quality-adjusted life expectancy, lifetime costs, and incremental cost-effectiveness ratios.


RESULTS
For a cohort of 60-year-old men with presumed-benign gastric ulcers and a 2.6% prevalence of undetected malignancy, the lifetime gastric cancer risk was 4.4%. Surveillance improved (undiscounted) life expectancy by 10.0 days and increased discounted quality-adjusted life expectancy by 3.4 days at a cost of $146,700 per quality-adjusted life year (QALY). Surveillance cost less than $50,000 per QALY if the undetected gastric cancer prevalence was 6.5%, and it cost less than $100,000 per QALY if the prevalence was greater than 3.5%, endoscopy costs were 40% lower, or the disutility associated with gastric cancer was 30% lower. Probabilistic sensitivity analysis suggested that at a willingness-to-pay threshold of $100,000 per QALY, the probability that surveillance was cost effective was 25.2%.


CONCLUSIONS
Data from multiple sources with varied study designs were used.


CONCLUSIONS
Endoscopic surveillance of presumed-benign gastric ulcers may improve overall survival. However, unless the prevalence of having undetected malignancy exceeds 6%, surveillance is unlikely to be cost-effective.
Yeh
Jennifer M
JM
Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Ho
Wendy
W
Hur
Chin
C
D000359:Aftercare / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000191:economics*; D016481:Helicobacter Infections / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013274:Stomach Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D013276:Stomach Ulcer / Q000191:economics* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D015996:Survival Rate