title: Endoscopy for upper GI cancer screening in the general population: a cost-utility analysis.
abstract: BACKGROUND
  Colon cancer screening with colonoscopy is an accepted strategy; however, there are limited data regarding the cost-effectiveness of screening for upper GI cancers (esophageal adenocarcinoma with its premalignant precursor Barrett's esophagus, esophageal squamous cell cancer, gastric adenocarcinoma) in the United States.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of screening the general population for upper GI cancers by performing an upper endoscopy at the time of screening colonoscopy.
  
  
  METHODS
  Decision analysis.
  
  
  METHODS
  Third-party-payer perspective with a time horizon of 30 years or until death.
  
  
  METHODS
  This study involved 50-year-old patients already undergoing screening colonoscopy.
  
  
  METHODS
  Comparison of two strategies: performing and not performing a screening upper endoscopy at the time of screening colonoscopy.
  
  
  METHODS
  Incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  One-time screening for the general population at the age of 50 for upper GI cancers required $115,664 per quality-adjusted life year (QALY) compared with no screening or surveillance. A strategy of screening and surveillance for Barrett's esophagus required only $95,559 per QALY saved. In 1-way sensitivity analyses, the prevalence rates of esophageal adenocarcinoma, esophageal squamous cell cancer, or gastric adenocarcinoma would have to increase by 654%, 1948%, and 337%, respectively, to generate an ICER of less than $50,000 per QALY.
  
  
  CONCLUSIONS
  Omission of premalignant conditions for squamous cell cancer and gastric adenocarcinoma.
  
  
  CONCLUSIONS
  The ICER for screening the general population for upper GI cancers with endoscopy remains high, despite accounting for reduced endoscopy costs and the combined benefits of detecting early esophageal adenocarcinoma, esophageal squamous cell cancer, and gastric adenocarcinoma. However, the ICER compares favorably with commonly performed screening strategies for other cancers.
authors: Division of Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas, USA.
authors: Neil
authors: N
authors: Gupta
authors: Ajay
authors: A
authors: Bansal
authors: Sachin B
authors: SB
authors: Wani
authors: Srinivas
authors: S
authors: Gaddam
authors: Amit
authors: A
authors: Rastogi
authors: Prateek
authors: P
authors: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000191:economics* / Q000473:pathology / Q000517:prevention & control; D001471:Barrett Esophagus / Q000175:diagnosis / Q000191:economics* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000473:pathology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D004938:Esophageal Neoplasms / Q000191:economics* / Q000473:pathology / Q000517:prevention & control; D004945:Esophagoscopy / Q000191:economics; D005773:Gastroscopy / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D011159:Population Surveillance; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics* / Q000473:pathology; D019057:Quality-Adjusted Life Years; D013274:Stomach Neoplasms / Q000191:economics* / Q000473:pathology / Q000517:prevention & control