title: Screening for gastric cancer and surveillance of premalignant lesions: a systematic review of cost-effectiveness studies.
abstract: BACKGROUND
  Cost-effectiveness studies are highly dependent on the models, settings, and variables used and should be based on systematic reviews. We systematically reviewed cost-effectiveness studies that address screening for gastric cancer and/or surveillance of precancerous conditions and lesions.
  
  
  METHODS
  A systematic review of cost-effectiveness studies was performed by conducting a sensitive search in seven databases (PubMed, Scopus, Web of Science, Current Contents Connect, Centre for Reviews and Dissemination, Academic Search Complete, and CINAHL Plus), independently evaluated by two investigators. Articles were evaluated for type of study, perspective, model, intervention, incremental cost-effectiveness ratio, clinical or cost variables, and quality, according to published guidelines.
  
  
  RESULTS
  From 2395 abstracts, 23 articles were included: 19 concerning population screening and 4 on following up premalignant lesions. Studies on Helicobacter pylori screening concluded that serology was cost-effective, depending on cancer incidence and endoscopy cost (incremental cost-effectiveness ratio: 6264-25,881), and eradication after endoscopic resection was also cost-effective (dominant) based on one study. Studies on imaging screening concluded that endoscopy was more cost-effective than no screening (incremental cost-effectiveness ratio: 3376-26,836). Articles on follow-up of premalignant lesions reported conflicting results (incremental cost-effectiveness ratio: 1868-72,519 for intestinal metaplasia; 18,600-39,800 for dysplasia). Quality assessment revealed a unanimous lack of a detailed systematic review and fulfillment of a median number of 23 items (20-26) of 35 possible ones.
  
  
  CONCLUSIONS
  The available evidence shows that Helicobacter pylori serology or endoscopic population screening is cost-effective, while endoscopic surveillance of premalignant gastric lesions presents conflicting results. Better implementation of published guidelines and accomplishment of systematic detailed reviews are needed.
authors.affiliation: CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal. miguel.areia@netcabo.pt
authors.forename: Miguel
authors.initials: M
authors.lastname: Areia
authors.forename: Rita
authors.initials: R
authors.lastname: Carvalho
authors.forename: Ana Teresa
authors.initials: AT
authors.lastname: Cadime
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha Gonçalves
authors.forename: Mário
authors.initials: M
authors.lastname: Dinis-Ribeiro
mesh_terms: D003362:Cost-Benefit Analysis; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D012698:Serologic Tests / Q000191:economics / Q000379:methods; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology
keywords: Atrophic gastritis; Helicobacter pylori; Review; cost-effectiveness; costs and benefits; early detection of cancer; gastric cancer; gastric neoplasm; gastrointestinal endoscopy; intestinal metaplasia; stomach neoplasm