title: The societal gain of medical development and innovation in gastroenterology.
abstract: BACKGROUND
  Gastroenterology has over the past 30 years evolved very rapidly. The societal benefits to which this has led are incompletely determined, yet form a mandate to determine the need for future innovations and further development of the field. A more thorough understanding of societal benefits may help to determine future goals and improve decision making.
  
  
  OBJECTIVE
  The objective of this article is to determine the societal gains of medical innovations in the field of gastroenterology in the past and future, using peptic ulcer disease as an example of past innovation and the implementation of colorectal cancer screening as an illustration of future gains.
  
  
  METHODS
  Literature searches were performed for data on peptic ulcer and colorectal cancer epidemiology, treatment outcomes, and costs. National and governmental databases in the Netherlands were searched to obtain the input for calculations of quality-adjusted life years (QALYs), health-adjusted life expectancy (HALE), and the corresponding societal benefit.
  
  
  RESULTS
  Since 1980 the improvements in peptic ulcer treatment have had a limited impact on life expectancy, rising from 83.6 years to 83.7 years, but have led to a yearly gain of 46,000 QALYs, caused by improved quality of life. These developments in the field of peptic ulcer translated into a yearly gain of 1.8 billion to 7.8 billion euros in 2008 compared with the 1980s. Mortality due to colorectal cancer is high, with 21.6 deaths per 100,000 per year in the Netherlands (European Standardized Rate (ESR)). The future implementation of a nationwide call-recall colorectal cancer screening by means of biennial fecal immunochemical testing (FIT) is expected to result in a 50%-80% mortality reduction and thus a gain of an estimated 35,000 life years per year, corresponding to 26,000 QALYs per year. The effects of the implementation of FIT screening can be translated to a future societal gain of 1.0 billion to 4.4 billion euro.
  
  
  CONCLUSIONS
  The innovations and developments in the field of gastroenterology have led to significant societal gains in the past three decades. This process will continue in the near future as a result of further developments. These calculations provide a template for calculations on the need for specialist training as well as research and implementation of new developments in our field.
authors.affiliation: Departments of Gastroenterology and Hepatology.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: den Hoed
authors.affiliation: Gupta Strategists, Ophemert, the Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Isendoorn
authors.affiliation: Gupta Strategists, Ophemert, the Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Klinkhamer
authors.affiliation: Gupta Strategists, Ophemert, the Netherlands.
authors.forename: Anshu
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Departments of Gastroenterology and Hepatology ; Departments of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
keywords: Peptic ulcer; colon cancer; quality of life; screening; societal gain