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Helicobacter. 2014 Dec;19(6):425-36. doi: 10.1111/hel.12150. Epub 2014 Aug 28.

Cost-utility analysis of endoscopic surveillance of patients with gastric premalignant conditions.

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CINTESIS - Center for Research in Health Technologies and Information Systems, Faculty of Medicine, Porto University, Porto, Portugal; Gastroenterology Department, Portuguese Oncology Institute - Coimbra, Coimbra, Portugal.



Progression of extensive gastric premalignant conditions to cancer might warrant surveillance programms. Recent guidelines suggest a 3-yearly endoscopic follow-up for these patients. Our aim was to determine the cost utility of endoscopic surveillance of patients with extensive gastric premalignant conditions such as extensive atrophy or intestinal metaplasia.


A cost-utility economic analysis was performed from a societal perspective in Portugal using a Markov model to compare two strategies: surveillance versus no surveillance. Clinical data were collected from a systematic review of the literature, costs from published national data, and community utilities derived from a population study by the EuroQol questionnaire in terms of quality-adjusted life years (QALY). Population started at age 50, for a time horizon of 25 years and an annual discount rate of 3% was used for cost and effectiveness. Primary outcome was the incremental cost-effectiveness ratio (ICER) of a 3-yearly endoscopic surveillance versus no surveillance for a base case scenario and in deterministic and probabilistic sensitivity analysis. Secondary outcomes were ICER of 5- and 10-yearly endoscopic surveillance versus no surveillance.


Endoscopic surveillance every 3 years provided an ICER of € 18,336, below the adopted threshold of € 36,575 which corresponds to the proposed guideline limit of USD 50,000 and this strategy dominated surveillance every 5 or 10 years. Utilities for endoscopic treatment were relevant in deterministic analysis, while probabilistic analysis showed that in 78% of cases the model was cost-effective.


Endoscopic surveillance every 3 years of patients with premalignant conditions is cost-effective.


Atrophic gastritis; cost-benefit analysis; cost-effectiveness; gastric neoplasm; gastrointestinal endoscopy

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