Cost-effectiveness analysis of different enhanced magnifying endoscopic technologies for early gastric cancer screening

Abstract

Objective To assess and compare the cost-effectiveness of different enhanced magnifying endoscopic technologies for early gastric cancer screening in Chinese patients with focal gastric lesions. Methods Target population was Chinese patients over forty years old with focal gastric lesions. A decision-tree model was constructed to compare the costs and clinical effectiveness of different endoscopic technologies for early gastric cancer screening. The endoscopic technologies included conventional white light endoscopy(WLE), magnifying endoscopy enhanced with narrow-band imaging(ME-NBI), magnifying endoscopy enhanced by epinephrine(ME-EPI), magnifying endoscopy enhanced by indigo carmine(ME-IDC) and magnifying endoscopy enhanced by acetic acid-indigo carmine mixture(ME-AIM). The main outcomes were the number of detected early gastric cancer and precancerous lesions. Data for base analysis mainly came from research results of domestic multicenter, large-scale opportunistic screening for early gastric cancer. Sensitivity analysis was conducted by using one-way sensitivity analysis. Results The estimated clinical benefit was similar for the four different enhanced magnifying endoscopic technologies. However, the screening cost was lower when using ME-AIM. ME-AIM had the best cost-effectiveness compared with three other technologies. The results showed morbidity of early gastric cancer in Chinese patients with early gastric cancer and precancerous lesions, the sensitivity and the cost of ME-AIM were the 3 main factors that influenced cost-effectiveness. Conclusion ME-AIM may be the most cost-effective for early gastric cancer screening in Chinese patients with focal gastric lesions. Key words: Stomach neoplasms; Cost-benefit analysis; Endoscopy, gastrointestinal; Early gastric cancer; Magnifying endoscopy