Endoscopic screening for gastric cancer cost-effective for Asian Americans in the U.S.
Endoscopic screening for gastric cancer with surveillance of gastric preneoplasia was cost-effective for Asian Americans aged at least 50 years, according to study results.
Shajia C. Shah, MD, MPH, of the division of gastroenterology at Vanderbilt University Medical Center, and colleagues wrote that gastric cancer incidence is low in the United States, but immigrants from higher incidence countries retain their higher risk.
“While the U.S. is overall considered a low-to-intermediate incidence country for gastric cancer, there are clear racial/ethnic differences in disease burden,” they wrote, adding that compared with the white U.S. population, the Hispanic and Black populations have approximately twofold higher gastric cancer incidence rates, while some Asian American groups have up to 6.6-fold higher rates.
To determine the cost effectiveness of different endoscopic screening strategies for noncardia gastric cancer, researchers generated a decision-analytic Markov model to simulate a cohort of asymptomatic Asian Americans aged at least 50 years. They compared two different gastric cancer screening strategies with no screening among Chinese, Filipino, Southeast Asian, Vietnamese, Korean and Japanese Americans.
Compared with no endoscopic screening, investigators determined that performing a one-time upper endoscopy with biopsies, followed by continued endoscopic surveillance if gastric intestinal metaplasia was identified as cost effective. However, they found that performing ongoing, biennial endoscopies, even among patients with normal findings from endoscopy and histopathology, was not.
Shah and colleagues found that the lowest incremental cost-effectiveness ratios were among individuals in the Chinese, Japanese and Korean American populations, which were all below $73,748 per quality-adjusted life-year.
“The potential health and economic detriment of continued inertia surrounding gastric cancer screening is amplified when considering that the pool of at-risk individuals is only expected to grow, with non-Hispanic whites now considered the minority population in 35 of the 50 largest cities and projections that non-Hispanic whites will no longer be the overall majority population by 2065,” Shah and colleagues wrote. “These findings could therefore have major public health implications.”