Dataset Information

Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.

ABSTRACT: Gastric cancer is one of the most common gastrointestinal cancers. Early diagnosis can improve the 5-year survival rate. This study aimed to evaluate the cost-effectiveness of Helicobacter pylori (Hp) and a new gastric cancer screening scoring system (NGCS) in areas with a high incidence of gastric cancer. A decision-analytic Markov model was constructed based on the theory and method of cost-effectiveness analysis, which included three decisions: no screening, Hp screening, and NGCS screening. The uncertainty of each parameter in the model was determined using a one-way sensitivity analysis and probability sensitivity analysis. The results of the cost-effectiveness analysis revealed that the application of the NGCS had the highest cost-effectiveness, while the one-way sensitivity analysis revealed that the probability of intestinal metaplasia progression to dysplasia had the most significant effect on the incremental cost-effectiveness ratio. The probability sensitivity analysis concluded that the result of the NGCS having the highest cost-effectiveness was stable. Although the application of the NGCS will require upfront screening costs, it can significantly improve the detection rate of early gastric cancer and save the consequent long-term healthcare costs. It is practicable and can be popularized in China.

SUBMITTER: Zheng P

PROVIDER: S-EPMC9857951 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.

Zheng Peiyu P Liu Jinchun J

Current oncology (Toronto, Ont.) 20230113 1

Gastric cancer is one of the most common gastrointestinal cancers. Early diagnosis can improve the 5-year survival rate. This study aimed to evaluate the cost-effectiveness of Helicobacter pylori (Hp) and a new gastric cancer screening scoring system (NGCS) in areas with a high incidence of gastric cancer. A decision-analytic Markov model was constructed based on the theory and method of cost-effectiveness analysis, which included three decisions: no screening, Hp screening, and NGCS screening. ...[more]

PMID: 36661735

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Project description:BackgroundWe aimed to evaluate the clinical applicability of a new scoring system that comprises the variables age, sex, pepsinogen ratio (PGR), gastrin-17 (G-17), and Helicobacter pylori (Hp) infection for gastric cancer (GC) screening in the Wannan region, China. We also explored the risk factors of GC in the Wannan region.MethodsWe prospectively enrolled asymptomatic participants from January 1, 2019 to June 30, 2021 at the First Affiliated Hospital of Wannan Medical College. We used a receiver operating characteristic (ROC) curve to estimate the screening value of combined measurements of pepsinogen I, PGII, PGR, G-17, and Hp. Univariate analysis and multivariate analysis were used to explore the independent risk factors of GC.ResultsA total of 25,194 asymptomatic patients were eventually screened. The area under the ROC curve (AUC) of combined measurements was 0.817 (95% confidence interval [CI] 0.721-0.913), the sensitivity was 81.5%, and the specificity was 77.8%. The detection rate of this new scoring system for GC screening in low-, medium-, and high-risk groups was 0%, 1.63%, and 9%, respectively (P < 0.001). Multivariate analysis showed that age (odds ratio [OR], 5.934; 95% CI 3.695-9.529; P < 0.001), sex (OR 5.721; 95% CI 2.579-12.695; P < 0.001), Hp infection (OR 1.992; 95% CI 1.255-3.163; P = 0.003), a history of smoking (OR 2.028; 95% CI 1.213-3.392; P = 0.007), consuming a high-salt diet (OR 2.877; 95% CI 1.807-4.580; P < 0.001), frequently eating pickled foods (OR 1.873; 95% CI 1.125-3.120; P = 0.016), and frequently eating fried foods (OR 2.459; 95% CI 1.384-4.369; P = 0.002) were independent risk factors for GC and precancerous lesions. However, frequent consumption of green vegetables (OR 0.388; 95% CI 0.242-0.620; P < 0.001) was an independent protective factor against GC and precancerous lesions.ConclusionThe new scoring system for GC screening was feasible in the Wannan region, especially in high-risk populations. Frequent consumption of green vegetables was an independent protective factor against GC and precancerous lesions.

Project description:BackgroundConventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN.MethodsA decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY.ResultsLiterature review suggests that rate of IPNs in the upper portion of the lung varied from 47 to 76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields.ConclusionConventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80 k/QALY) and colon cancer (colonoscopy $6 k/QALY). Prospective studies are appropriate to define protocols for FCT.

Project description:ObjectivesTo evaluate the cost-effectiveness of human papillomavirus (HPV) DNA testing (versus Papanicolaou (Pap)-based screening) for cervical cancer screening in Nicaragua.DesignA previously developed Monte Carlo simulation model of the natural history of HPV infection and cervical cancer was calibrated to epidemiological data from Nicaragua. Cost data inputs were derived using a micro-costing approach in Carazo, Chontales and Chinandega departments; test performance data were from a demonstration project in Masaya department.SettingNicaragua's public health sector facilities.ParticipantsWomen aged 30-59 years.InterventionsScreening strategies included (1) Pap testing every 3 years, with referral to colposcopy for women with an atypical squamous cells of undetermined significance or worse result ('Pap'); (2) HPV testing every 5 years, with referral to cryotherapy for HPV-positive eligible women (HPV cryotherapy or 'HPV-Cryo'); (3) HPV testing every 5 years, with referral to triage with visual inspection with acetic acid (VIA) for HPV-positive women ('HPV-VIA'); and (4) HPV testing every 5 years, with referral to Pap testing for HPV-positive women ('HPV-Pap').Outcome measuresReduction in lifetime risk of cancer and incremental cost-effectiveness ratios (ICER; 2015 US$ per year of life saved (YLS)).ResultsHPV-based screening strategies were more effective than Pap testing. HPV-Cryo was the least costly and most effective strategy, reducing lifetime cancer risk by 29.5% and outperforming HPV-VIA, HPV-Pap and Pap only, which reduced cancer risk by 19.4%, 12.2% and 10.8%, respectively. With an ICER of US$320/YLS, HPV-Cryo every 5 years would be very cost-effective using a threshold based on Nicaragua's per capita gross domestic product of US$2090. Findings were robust across sensitivity analyses on test performance, coverage, compliance and cost parameters.ConclusionsHPV testing is very cost-effective compared with Pap testing in Nicaragua, due to higher test sensitivity and the relatively lower number of visits required. Increasing compliance with recommended follow-up will further improve the health benefits and value for public health dollars.

Dataset Information

Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.

Publications

Cost-Effectiveness Analysis of Hp and New Gastric Cancer Screening Scoring System for Screening and Prevention of Gastric Cancer.

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