Follow up PES(在美國) for presumed benign GU是不合成本效益的，除非針對族群的cancer risk >6%
但在台灣這種賤價健保，也許追蹤式胃鏡就合乎cost-benefit ratio了
60 y/o men 有GU的，約有2.6% 可能是cancer, 而 life long gastric cancer expectancy 4.4%，做追蹤式胃鏡可以延長10天生命，延長2.6天 QALY(quality adjusted life year)at a cost of 146700 US dollars per year
如果cancer pervelance rate 6%或是PES便宜些還適合一些
公衛蛋頭做的數字，在臨床上有何意義?
結論，第一次做就要做好biopsy要biopsy 對，後面做的low yield with high cost
Is Endoscopic Surveillance of Gastric Ulcers Cost-Effective?
Probably not, unless the prevalence of undetected malignancy exceeds 6%
The practice of proving that a gastric ulcer is healed to rule out malignancy is a holdover from the days of barium studies. This strategy nevertheless remains common, despite multiple analyses that have shown its value to be minimal. Now, investigators have evaluated the long-term costs and benefits of using endoscopic surveillance of gastric ulcers to detect malignancy. They used a Markov decision-analytic model with inputs from clinical and epidemiologic studies.
The base-case cohort comprised 60-year-old men with presumed-benign gastric ulcers and a 2.6% prevalence of undetected malignancy. In this group, the lifetime risk for gastric cancer was estimated to be 4.4%. Follow-up endoscopic surveillance to document healing increased life expectancy by 10 days and increased quality-adjusted life expectancy by 2.6 days at a cost of US$146,700 per quality-adjusted life year (QALY). Sensitivity analysis showed that increasing the prevalence of undetected cancers or decreasing the cost of endoscopy could reduce the cost per QALY. The probability that surveillance would cost less than $100,000 per QALY was 25%. The authors concluded that unless the prevalence of undetected cancer exceeds 6%, surveillance is unlikely to be cost-effective; however, it might still be appropriate in high-risk patients.
Comment: The assumptions used in decision-analytic models can always be questioned. This study's findings, consistent with those from previous analyses, demonstrate that universal surveillance for malignancy in endoscopically diagnosed gastric ulcers has a low yield and a high cost. Pursuing such an approach is simply untenable in an era of limited healthcare resources. A better approach to ruling out malignancy in gastric ulcers is to ensure careful endoscopic and histological evaluation at the time of the index endoscopy.
— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)
Published in Journal Watch Gastroenterology July 30, 2010
Citation(s):
Yeh JM et al. Cost-effectiveness of endoscopic surveillance of gastric ulcers to improve survival. Gastrointest Endosc 2010 Jul; 72:33.
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7NjdmNWZiYjctNDUxNi00YTEzLTk3ZjctZGZiOTNhZWVmZjdm&hl=zh_TW
60 y/o men 有GU的，約有2.6% 可能是cancer, 而 life long gastric cancer expectancy 4.4%，做追蹤式胃鏡可以延長10天生命，延長2.6天 QALY(quality adjusted life year)at a cost of 146700 US dollars per year
如果cancer pervelance rate 6%或是PES便宜些還適合一些
公衛蛋頭做的數字，在臨床上有何意義?
結論，第一次做就要做好biopsy要biopsy 對，後面做的low yield with high cost
Is Endoscopic Surveillance of Gastric Ulcers Cost-Effective?
Probably not, unless the prevalence of undetected malignancy exceeds 6%
The practice of proving that a gastric ulcer is healed to rule out malignancy is a holdover from the days of barium studies. This strategy nevertheless remains common, despite multiple analyses that have shown its value to be minimal. Now, investigators have evaluated the long-term costs and benefits of using endoscopic surveillance of gastric ulcers to detect malignancy. They used a Markov decision-analytic model with inputs from clinical and epidemiologic studies.
The base-case cohort comprised 60-year-old men with presumed-benign gastric ulcers and a 2.6% prevalence of undetected malignancy. In this group, the lifetime risk for gastric cancer was estimated to be 4.4%. Follow-up endoscopic surveillance to document healing increased life expectancy by 10 days and increased quality-adjusted life expectancy by 2.6 days at a cost of US$146,700 per quality-adjusted life year (QALY). Sensitivity analysis showed that increasing the prevalence of undetected cancers or decreasing the cost of endoscopy could reduce the cost per QALY. The probability that surveillance would cost less than $100,000 per QALY was 25%. The authors concluded that unless the prevalence of undetected cancer exceeds 6%, surveillance is unlikely to be cost-effective; however, it might still be appropriate in high-risk patients.
Comment: The assumptions used in decision-analytic models can always be questioned. This study's findings, consistent with those from previous analyses, demonstrate that universal surveillance for malignancy in endoscopically diagnosed gastric ulcers has a low yield and a high cost. Pursuing such an approach is simply untenable in an era of limited healthcare resources. A better approach to ruling out malignancy in gastric ulcers is to ensure careful endoscopic and histological evaluation at the time of the index endoscopy.
— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)
Published in Journal Watch Gastroenterology July 30, 2010
Citation(s):
Yeh JM et al. Cost-effectiveness of endoscopic surveillance of gastric ulcers to improve survival. Gastrointest Endosc 2010 Jul; 72:33.
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7NjdmNWZiYjctNDUxNi00YTEzLTk3ZjctZGZiOTNhZWVmZjdm&hl=zh_TW
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