Gastric-cancer screening in high-risk groups cost-effective

Last Updated: 2018-05-29

By Anne Harding

NEW YORK (Reuters Health) - Gastric-cancer screening could be cost-effective in high-risk racial and ethnic groups in the U.S., according to a new modeling study.

When detected at an early, resectable stage, gastric adenocarcinoma (GA) has a five-year survival rate of 95% to 99%. But survival is less than 30% for GA diagnosed later, Dr. Shailja C. Shah of Vanderbilt University Medical Center in Nashville and her colleagues note in Gastroenterology, online May 17.

Some countries where noncardia intestinal-type gastric adenocarcinoma (NCGA) is endemic, including Japan and Korea, screen for the disease, the researchers add. These programs have reduced morbidity and mortality from NCGA in part thanks to early detection and treatment, and are cost-effective.

In the U.S., three-quarters of NCGAs are diagnosed when the disease is advanced, Dr. Shah and her team point out. While the overall low prevalence of NCGA means population-based screening is not recommended, they add, screening high-risk subgroups could be beneficial.

To investigate, they created a Markov model to estimate the cost effectiveness of screening non-Hispanic whites, Hispanics, non-Hispanic blacks and Asians starting at age 50.

Screening with upper endoscopy (EGD) and additional surveillance only if the test identified intestinal metaplasia (IM) or more severe pathology was cost effective for non-Hispanic blacks ($80,278 per quality-adjusted life year), Hispanics ($76,070/QALY) and Asians ($71,451/QALY). But it was not cost-effective for non-Hispanic whites, at $122,428/QALY.

Screening for NCGA would work similarly to colorectal cancer (CRC) screening, Dr. Shah noted in a telephone interview with Reuters Health, allowing clinicians to detect and remove lesions and step up surveillance as needed. While the American Society of Gastrointestinal Endoscopy recommends NCGA screening for high-risk groups, she added, "there are no actual guidelines that are set in place, so it's not a universal practice. At least for higher-risk populations, it should definitely be considered."

Insurers may not cover NCGA screening if a person does not have symptoms, Dr. Shah added, which was once the case with CRC screening. "Hopefully we're moving in a positive direction to show that this is a cost-effective intervention and could be covered for these high-risk populations."

SOURCE: https://bit.ly/2JfJ6w6

Gastroenterology 2018.