title: Cost-utility analysis of endoscopic surveillance of patients with gastric premalignant conditions.
abstract: BACKGROUND
  Progression of extensive gastric premalignant conditions to cancer might warrant surveillance programms. Recent guidelines suggest a 3-yearly endoscopic follow-up for these patients. Our aim was to determine the cost utility of endoscopic surveillance of patients with extensive gastric premalignant conditions such as extensive atrophy or intestinal metaplasia.
  
  
  METHODS
  A cost-utility economic analysis was performed from a societal perspective in Portugal using a Markov model to compare two strategies: surveillance versus no surveillance. Clinical data were collected from a systematic review of the literature, costs from published national data, and community utilities derived from a population study by the EuroQol questionnaire in terms of quality-adjusted life years (QALY). Population started at age 50, for a time horizon of 25 years and an annual discount rate of 3% was used for cost and effectiveness. Primary outcome was the incremental cost-effectiveness ratio (ICER) of a 3-yearly endoscopic surveillance versus no surveillance for a base case scenario and in deterministic and probabilistic sensitivity analysis. Secondary outcomes were ICER of 5- and 10-yearly endoscopic surveillance versus no surveillance.
  
  
  RESULTS
  Endoscopic surveillance every 3 years provided an ICER of € 18,336, below the adopted threshold of € 36,575 which corresponds to the proposed guideline limit of USD 50,000 and this strategy dominated surveillance every 5 or 10 years. Utilities for endoscopic treatment were relevant in deterministic analysis, while probabilistic analysis showed that in 78% of cases the model was cost-effective.
  
  
  CONCLUSIONS
  Endoscopic surveillance every 3 years of patients with premalignant conditions is cost-effective.
authors.affiliation: CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal; Gastroenterology Department, Portuguese Oncology Institute - Coimbra, Coimbra, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Areia
authors.forename: Mário
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.forename: Francisco
authors.initials: F
authors.lastname: Rocha Gonçalves
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D004724:Endoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D011230:Precancerous Conditions / Q000175:diagnosis / Q000191:economics* / Q000473:pathology; D018571:Sentinel Surveillance; D013272:Stomach Diseases / Q000175:diagnosis / Q000191:economics* / Q000473:pathology
keywords: Atrophic gastritis; cost-benefit analysis; cost-effectiveness; gastric neoplasm; gastrointestinal endoscopy