Endoscopy for Gastric Cancer Screening Is Cost Effective for Asian Americans in the United States

Abstract

Background & aims: Endoscopic screening for gastric cancer is routine in some countries with high incidence and is associated with reduced gastric cancer-related mortality. Immigrants from countries of high incidence to low incidence of gastric cancer retain their elevated risk, but no screening recommendations have been made for these groups in the United States. We aimed to determine the cost effectiveness of different endoscopic screening strategies for noncardia gastric cancer, compared with no screening, among Chinese, Filipino, Southeast Asian, Vietnamese, Korean, and Japanese Americans.

Methods: We generated a decision-analytic Markov model to simulate a cohort of asymptomatic 50-year-old Asian Americans. The cost effectiveness of 2 distinct strategies for endoscopic gastric cancer screening was compared with no screening for each group, stratified by sex. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay threshold of $100,000/quality-adjusted life-year (QALY). Extensive sensitivity analyses were performed.

Results: Compared with performing no endoscopic gastric cancer screening, performing a 1-time upper endoscopy with biopsies, with continued endoscopic surveillance if gastric intestinal metaplasia was identified, was cost effective, whereas performing ongoing biennial endoscopies, even for patients with normal findings from endoscopy and histopathology, was not. The lowest ICERs were observed for Chinese, Japanese, and Korean Americans (all <$73,748/QALY).

Conclusions: Endoscopic screening for gastric cancer with ongoing surveillance of gastric preneoplasia is cost effective for Asian Americans ages 50 years or older in the United States. The lowest ICERs were for Chinese, Japanese, and Korean Americans (all <$73,748/QALY).

Keywords: Cost-Benefit Analysis; Early Detection; Health Care Disparity; Helicobacter pylori; Public Health.

Figure 1.. Markov model simulating gastric cancer screening for Asian American ethnic groups.

Adapted from Saumoy et al. Gastroenterology 2018; 155: 648–60.

Figure 2.. Cost-effectiveness (CE) acceptability curves for gastric cancer screening modalities in Asian American males.

One-time EGD at the time of colonoscopy for colorectal cancer screening with GIM surveillance if indicated (see text) is cost-effective for all six AA ethnicities (a: Chinese American; b: Japanese American; c: Korean American; d: Vietnamese American; e: Filipino American; f: Southeast Asian American). Biennial endoscopy and the no endoscopic screening strategies were not cost-effective for any group.

Figure 3.. Cost-effectiveness (CE) acceptability curves for gastric cancer screening modalities in Asian American females.

One-time EGD at the time of colonoscopy for colorectal cancer screening with GIM surveillance if indicated (see text) is cost-effective for all six AA groups (a: Chinese American; b: Japanese American; c: Korean American; d: Vietnamese American; e: Filipino American; f: Southeast Asian American). Biennial endoscopy and the no endoscopic screening strategies were not cost-effective for any group.