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Screening for gastric cancer and surveillance of premalignant lesions

October's issue of Helicobacter reviews the cost-effectiveness of screening for gastric cancer and surveillance of premalignant lesions.

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Cost-effectiveness studies are highly dependent on the models, settings, and variables used and should be based on systematic reviews.

Dr Miguel Areia and colleagues systematically reviewed cost-effectiveness studies that address screening for gastric cancer and/or surveillance of precancerous conditions and lesions.

A systematic review of cost-effectiveness studies was performed by conducting a sensitive search in 7 databases, independently evaluated by 2 investigators.

Endoscopy was more cost-effective than no screening
Helicobacter

The researchers evaluated articles for type of study, perspective, model, intervention, incremental cost-effectiveness ratio, clinical or cost variables, and quality, according to published guidelines.

From 2395 abstracts, 23 articles were included, including 19 concerning population screening and 4 on following up premalignant lesions.

Studies on Helicobacter pylori screening concluded that serology was cost-effective, depending on cancer incidence and endoscopy cost, and eradication after endoscopic resection was also cost-effective (dominant) based on one study.

The researchers found that studies on imaging screening concluded that endoscopy was more cost-effective than no screening.

Articles on follow-up of premalignant lesions reported conflicting results.

Quality assessment revealed a unanimous lack of a detailed systematic review, and fulfillment of a median number of 23 items of 35 possible ones.

Dr Areia's team commented, "The available evidence shows that Helicobacter pylori serology or endoscopic population screening is cost-effective, while endoscopic surveillance of premalignant gastric lesions presents conflicting results."

"Better implementation of published guidelines and accomplishment of systematic detailed reviews are needed."

Helicobacter 2013: 18(5): 325–337
12 September 2013

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