The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analysis

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dc.contributor.authorThiruvengadam, Nikhil R.
dc.contributor.authorGupta, Shashank
dc.contributor.authorBuller, Seth
dc.contributor.authorAwad, Imad
dc.contributor.authorGandhi, Devika
dc.contributor.authorIbarra, Allison
dc.contributor.authorLatorre, Gonzalo
dc.contributor.authorRiquelme, Arnoldo
dc.contributor.authorKochman, Michael L.
dc.contributor.authorCote, Gregory
dc.contributor.authorShah, Shailja C.
dc.contributor.authorSaumoy, Monica
dc.date.accessioned2025-01-20T17:09:43Z
dc.date.available2025-01-20T17:09:43Z
dc.date.issued2024
dc.description.abstractBACKGROUND & AIMS: Gastric intestinal metaplasia (GIM) is associated with a higher risk of noncardia intestinal gastric adenocarcinoma (GA). The aim of this study was to estimate lifetime benefits, complications, and cost-effectiveness of GIM surveillance using esophagogastroduodenoscopy (EGD).METHODS: We developed a semi-Markov microsimulation model of patients with incidentally detected GIM, to compare the effectiveness of EGD surveillance with no surveillance at 10-year, 5-year, 3-year, 2-year, and 1-year intervals. We modeled a simulated cohort of 1,000,000 US individuals aged 50 with incidental GIM. Outcome measures were lifetime GA incidence, mortality, number of EGDs, complications, undiscounted life-years gained, and incremental cost-effectiveness ratio with a willingness-to-pay threshold of $100,000/quality-adjusted life-year (QALY). RESULTS: In the absence of surveillance, the model simulated 32.0 lifetime GA cases and 23.0 lifetime GA deaths per 1000 individuals with GIM, respectively. Among surveilled individuals, simulated lifetime GA incidence (per 1000) decreased with shorter surveillance intervals (10-year to 1 year, 11.2-6.1) as did GA mortality (7.4-3.6). Compared with no surveillance, all modeled surveillance intervals yielded greater life expectancy (87-190 undiscounted life-years gained per 1000); 5-year surveillance provided the greatest number of life-years gained per EGD performed and was the cost-effective strategy ($40,706/QALY). In individuals with risk factors of family history of GA or anatomically extensive, incomplete-type GIM intensified 3-year surveillance was cost-effective (incremental cost-effectiveness ratio $28,156/QALY and $87,020/ QALY, respectively). CONCLUSIONS: Using microsimulation modeling, surveillance of incidentally detected GIM every 5 years is associated with reduced GA incidence/mortality and is cost-effective from a health care sector perspective. Real-world studies evaluating the impact of GIM surveillance on GA incidence and mortality in the United States are needed.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.cgh.2023.05.028
dc.identifier.eissn1542-7714
dc.identifier.issn1542-3565
dc.identifier.urihttps://doi.org/10.1016/j.cgh.2023.05.028
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/91067
dc.identifier.wosidWOS:001147333600001
dc.issue.numero1
dc.language.isoen
dc.pagina.final61
dc.pagina.inicio51
dc.revistaClinical gastroenterology and hepatology
dc.rightsacceso restringido
dc.subjectGastric Intestinal Metaplasia
dc.subjectEndoscopic Surveillance
dc.subjectMicrosimulation Modeling
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleThe Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally Detected Gastric Intestinal Metaplasia: A Microsimulation Analysis
dc.typeartículo
dc.volumen22
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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