Cost-effectiveness of endoscopic surveillance of gastric ulcers to improve survival

Gastrointest Endosc. 2010 Jul;72(1):33-43. doi: 10.1016/j.gie.2010.01.047. Epub 2010 Apr 28.


Background: Endoscopic surveillance of presumed-benign gastric ulcers may detect missed malignancy, but its impact on long-term outcomes is uncertain.

Objective: To estimate the clinical benefits and cost-effectiveness of follow-up surveillance.

Design: State-transition model.

Setting: To simulate the clinical course of presumed-benign gastric ulcers, we estimated prevalence and incidence of undetected gastric cancer, surveillance effectiveness, stage-specific disease mortality rates, and costs from clinical studies and databases.

Patients: This study involved 60-year-old men diagnosed with presumed-benign gastric ulcers.

Intervention: Follow-up endoscopic surveillance.

Main outcome measurements: Lifetime gastric cancer risk, life expectancy, quality-adjusted life expectancy, lifetime costs, and incremental cost-effectiveness ratios.

Results: For a cohort of 60-year-old men with presumed-benign gastric ulcers and a 2.6% prevalence of undetected malignancy, the lifetime gastric cancer risk was 4.4%. Surveillance improved (undiscounted) life expectancy by 10.0 days and increased discounted quality-adjusted life expectancy by 3.4 days at a cost of $146,700 per quality-adjusted life year (QALY). Surveillance cost less than $50,000 per QALY if the undetected gastric cancer prevalence was 6.5%, and it cost less than $100,000 per QALY if the prevalence was greater than 3.5%, endoscopy costs were 40% lower, or the disutility associated with gastric cancer was 30% lower. Probabilistic sensitivity analysis suggested that at a willingness-to-pay threshold of $100,000 per QALY, the probability that surveillance was cost effective was 25.2%.

Limitations: Data from multiple sources with varied study designs were used.

Conclusion: Endoscopic surveillance of presumed-benign gastric ulcers may improve overall survival. However, unless the prevalence of having undetected malignancy exceeds 6%, surveillance is unlikely to be cost-effective.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aftercare / economics*
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Follow-Up Studies
  • Gastroscopy / economics*
  • Helicobacter Infections / economics*
  • Helicobacter Infections / epidemiology
  • Helicobacter Infections / mortality
  • Helicobacter Infections / pathology
  • Helicobacter pylori*
  • Humans
  • Male
  • Markov Chains
  • Middle Aged
  • Prognosis
  • Quality-Adjusted Life Years
  • Stomach Neoplasms / economics*
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Stomach Ulcer / economics*
  • Stomach Ulcer / epidemiology
  • Stomach Ulcer / mortality
  • Stomach Ulcer / pathology
  • Survival Rate