Endoscopy Is Cost-Effective for Gastric Cancer Screening After Successful Helicobacter pylori Eradication

Abstract

After successful Helicobacter pylori eradication, patients with gastric mucosal atrophy are at high risk of gastric cancer. Endoscopy can detect early gastric cancer with high sensitivity. This study aimed to assess the cost-effectiveness of annual endoscopy versus biennial endoscopy versus no screening for gastric cancer screening in patients after successful Helicobacter pylori eradication. We developed decision trees with Markov models for a hypothetical cohort of patients aged 50years after successful Helicobacter pylori eradication over a lifetime horizon from a healthcare payer perspective. Main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs) with discounting at a fixed annual rate of 3%, and incremental cost-effectiveness ratios (ICERs). In a base-case analysis, biennial endoscopy (US$4305, 19.785QALYs, 19.938LYs) was more cost-effective than annual endoscopy (US$7516, 19.808QALYs, 19.958LYs, ICER; US$135,566/QALY gained) and no screening (US$14,326, 19.704QALYs, 19.873LYs). In scenario analyses, biennial endoscopy for patients with mild-to-moderate gastric mucosal atrophy and annual endoscopy for patients with severe gastric mucosal atrophy were the most cost-effective. Cost-effectiveness was sensitive to incidence of gastric cancer and the proportion of stage I. Probabilistic sensitivity analyses using Monte Carlo simulation demonstrated that at a willingness-to-pay level of US$100,000/QALY gained, biennial endoscopy was optimal 99.9% for patients with mild-to-moderate gastric mucosal atrophy, and that annual endoscopy was optimal 98.4% for patients with severe gastric mucosal atrophy. Based on cancer risk assessment of gastric mucosal atrophy and cost-effectiveness results, annual or biennial endoscopic surveillance could be established for patients after successful Helicobacter pylori eradication.