In the Journals

Gastric cancer screening cost-effective in some U.S. populations

Endoscopic noncardia gastric cancer screening might be cost effective among high-risk ethnicities in the United States, such as Hispanics, blacks and East Asians, despite low prevalence nationwide, according to research published in Gastroenterology.

Noncardia intestinal-type gastric adenocarcinoma (NCGA) screening is recommended in areas with high prevalence — particularly in Japan and Korea — as it is associated with reduced morbidity and mortality, Monica Saumoy, MD, MS, of the division of gastroenterology and hepatology at New York-Presbyterian Hospital, Weill Cornell Medical Center, and colleagues explained.

“By contrast, in the United States, 75% of NCGAs are diagnosed in the advanced stage with limited curative options and poor prognosis,” they wrote. “Because the U.S. is a relatively low-prevalence country, with gastric cancer ranked the 15th most common cancer overall, population-based NCGA screening is neither recommended nor has it been proven to be cost effective. However, NCGA screening for high-risk subgroups within otherwise low-intermediate prevalence areas has previously been shown to be a cost-effective intervention.”

Saumoy and colleagues developed an analytical model to determine whether selected NCGA screening for high-risk race and ethnicities within the U.S. could be cost effective.

The model used a base case of a 50-year-old person of either non-Hispanic white, non-Hispanic Black, Hispanic or Asian race or ethnicity and compared a no-screening strategy with two screening methods: upper endoscopy with biopsies and continued surveillance only if intestinal metaplasia or more sever pathology is identified; and upper endoscopy with biopsies every two years even in the absence of identified pathology. They determined an outcome measure using incremental cost-effectiveness ratios with a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY).

Endoscopy with additional surveillance only with evidence of intestinal metaplasia was cost effective for non-Hispanic blacks ($80,278/QALY), Hispanics ($76,070/QALY) and Asians ($71,451/QALY), but not for non-Hispanic whites ($122,428/QALY). Biennial screening regardless of histologic findings was not cost effective compared with the other screening strategies.

“Hispanics, non-Hispanic blacks, East Asians and other immigrant groups from areas where NCGA is endemic have at least 2 to 3 times the prevalence of NCGA as U.S.-born, non-Hispanic whites, if not higher, with a burden of disease even tantamount to colorectal cancer in some groups,” Saumoy and colleagues wrote. “We hope that our findings will stimulate efforts to address the racial and ethnic differences with respect to NCGA prevalence and mortality in the U.S. through implementation of a multimodal NCGA screening and surveillance protocol for high-risk groups in parallel with continued refinement of therapeutic endoscopic techniques and research focused on prevention efforts.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.

Endoscopic noncardia gastric cancer screening might be cost effective among high-risk ethnicities in the United States, such as Hispanics, blacks and East Asians, despite low prevalence nationwide, according to research published in Gastroenterology.

Noncardia intestinal-type gastric adenocarcinoma (NCGA) screening is recommended in areas with high prevalence — particularly in Japan and Korea — as it is associated with reduced morbidity and mortality, Monica Saumoy, MD, MS, of the division of gastroenterology and hepatology at New York-Presbyterian Hospital, Weill Cornell Medical Center, and colleagues explained.

“By contrast, in the United States, 75% of NCGAs are diagnosed in the advanced stage with limited curative options and poor prognosis,” they wrote. “Because the U.S. is a relatively low-prevalence country, with gastric cancer ranked the 15th most common cancer overall, population-based NCGA screening is neither recommended nor has it been proven to be cost effective. However, NCGA screening for high-risk subgroups within otherwise low-intermediate prevalence areas has previously been shown to be a cost-effective intervention.”

Saumoy and colleagues developed an analytical model to determine whether selected NCGA screening for high-risk race and ethnicities within the U.S. could be cost effective.

The model used a base case of a 50-year-old person of either non-Hispanic white, non-Hispanic Black, Hispanic or Asian race or ethnicity and compared a no-screening strategy with two screening methods: upper endoscopy with biopsies and continued surveillance only if intestinal metaplasia or more sever pathology is identified; and upper endoscopy with biopsies every two years even in the absence of identified pathology. They determined an outcome measure using incremental cost-effectiveness ratios with a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY).

Endoscopy with additional surveillance only with evidence of intestinal metaplasia was cost effective for non-Hispanic blacks ($80,278/QALY), Hispanics ($76,070/QALY) and Asians ($71,451/QALY), but not for non-Hispanic whites ($122,428/QALY). Biennial screening regardless of histologic findings was not cost effective compared with the other screening strategies.

“Hispanics, non-Hispanic blacks, East Asians and other immigrant groups from areas where NCGA is endemic have at least 2 to 3 times the prevalence of NCGA as U.S.-born, non-Hispanic whites, if not higher, with a burden of disease even tantamount to colorectal cancer in some groups,” Saumoy and colleagues wrote. “We hope that our findings will stimulate efforts to address the racial and ethnic differences with respect to NCGA prevalence and mortality in the U.S. through implementation of a multimodal NCGA screening and surveillance protocol for high-risk groups in parallel with continued refinement of therapeutic endoscopic techniques and research focused on prevention efforts.” – by Alex Young

Disclosures: The authors report no relevant financial disclosures.