title: Cost of detecting gastric neoplasia by surveillance endoscopy in atrophic gastritis in Italy: A low risk country.
abstract: BACKGROUND
  Atrophic gastritis (AG) is at increased risk of gastric neoplasia, thus surveillance gastroscopy has been proposed.
  
  
  OBJECTIVE
  To assess cost of detecting gastric neoplasias by surveillance endoscopy according to identified risk factors in Italy.
  
  
  METHODS
  Post-hoc analysis of a cohort study including 200 AG-patients from Italy followed up for a mean of 7.5 (4-23.4) years was done. Considered risk factors were: age >50years, extensive atrophy, pernicious anaemia, OLGA-OLGIM scores 3-4 at diagnosis. The number of 4-year-surveillance endoscopies needed to be performed to detect one gastric neoplasia (NNS) was calculated.
  
  
  RESULTS
  In 19 patients neoplasias (4 gastric cancers, 8 type 1 gastric carcinoids, 7 dysplasias) were detected at the 361 surveillance gastroscopies, corresponding to NNS of 19 and a cost per gastric neoplastic lesion of €2945. By restricting surveillance to pernicious anaemia patients, reduction of NNS and cost per neoplasia to 13.8 and €2139 may be obtained still detecting 74% of neoplasias. By limiting the surveillance to pernicious anaemia patients and OLGA 3-4, 5 (26.3%) neoplasias would have been detected with a corresponding NNS of 5.4 and a cost per lesion of €837.
  
  
  CONCLUSIONS
  Risk factors may allow an efficient allocation of financial and medical resources for endoscopic surveillance in AG in a low risk country.
authors.affiliation: Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy.
authors.forename: Edith
authors.initials: E
authors.lastname: Lahner
authors.affiliation: Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.affiliation: Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Department of Internal Medicine and Medical Specialties, University Sapienza, Rome, Italy.
authors.forename: Marilia
authors.initials: M
authors.lastname: Carabotti
authors.affiliation: Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
authors.affiliation: Department of Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal.
authors.forename: Mario
authors.initials: M
authors.lastname: Dinis-Ribeiro
authors.affiliation: Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sant'Andrea Hospital, School of Medicine, University Sapienza, Rome, Italy. Electronic address: bruno.annibale@uniroma1.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Annibale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000752:Anemia, Pernicious / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005757:Gastritis, Atrophic / Q000473:pathology*; D005773:Gastroscopy / Q000009:adverse effects / Q000191:economics*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007558:Italy; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D011230:Precancerous Conditions / Q000473:pathology*; D018570:Risk Assessment; D012307:Risk Factors; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology; D055815:Young Adult
keywords: Atrophic gastritis; Gastric neoplasia; Gastroscopy; Pernicious anaemia; Surveillance