Table 1.
Select model variables: base case and plausible ranges
| Variables | Base Case | Range | Reference |
|---|---|---|---|
| Natural history* | |||
| Disease progression | |||
| Gastritis to atrophy | 0.014-0.091 | ‡ | |
| Atrophy to intestinal metaplasia | 0.018-0.102 | ‡ | |
| Intestinal metaplasia to dysplasia | 0.004-0.017 | ‡ | |
| Dysplasia to invasive cancer† | 0.000-0.012 | ‡ | |
| Disease regression | |||
| Atrophy to gastritis | 0.005-0.046 | ‡ | |
| Intestinal metaplasia to atrophy | 0.002-0.055 | ‡ | |
| Dysplasia to intestinal metaplasia | 0.025-0.072 | ‡ | |
| Five-year gastric cancer survival rate, % | 24.3 | 3.4-61.1 | 27 |
|
| |||
| Clinical, % | |||
| Endoscopic diagnosis for dysplasia and gastric cancer | |||
| Sensitivity | 0.81 | 0.78-0.95 | 25, 26 |
| Specificity | 1.00 | 0.98-1.00 | 25, 26 |
| EMR complications | |||
| Bleeding | 0.017 | 0.012-0.205 | 28 |
| Perforation | 0.002 | 0.001-0.052 | 28 |
| Endoscopy complications | |||
| Bleeding | 0.001 | 0.0002-0.006 | 29, 30 |
| Perforation | 0.001 | 0.0002-0.006 | 29, 30 |
| EMR-eligible lesions | |||
| Dysplasia | 1.00 | 0.95-1.00 | 31-33 |
| Asymptomatic gastric cancer | 0.20 | 0.11-0.29 | 34 |
| Incomplete resection among EMR-eligible lesions | 0.26 | 0.02-0.53 | 35 |
| Require surgery | 0.36 | 0.07-0.50 | 34-36 |
| Surgical mortality risk | 0.06-0.16 | § | 37 |
|
| |||
| Outcomes after treatment | |||
| Dysplasia | |||
| Relative risk of progressing to invasive cancer∥ | |||
| Surgery | 0.06 | 0.07-0.36 | 35, 38-42 |
| Complete EMR | 0.02 | 0.00-0.06 | 35, 38-42 |
| Incomplete EMR | 0.14 | 0.07-0.36 | 35, 38-42 |
| Asymptomatic gastric cancer | |||
| Relative risk of dying from gastric cancer | |||
| Surgery | 0.53 | 0.30-0.70 | 43, 44 |
| Complete EMR | 0.00 | 0.00-0.06 | 35, 38-42 |
| Incomplete EMR | 0.53 | 0.30-0.70 | 43, 44 |
|
| |||
| Direct medical costs, U.S. 2007$** | |||
| Endoscopy (CPT 43239, 89130) | 871 | 435-1740 | 45 |
| EMR (CPT 43236, 43251, 89130) | 1071 | 535-2140 | 45 |
| Bleeding/perforation complications (CPT 43501, DRG 568) | 19,040 | 9,520-38,080 | 45 |
| Surgery | |||
| Dysplasia (CPT 43610, DRG 568) | 18,720 | 9,360-37,440 | 45 |
| Asymptomatic gastric cancer (CPT 43611, DRG 567) | 28,763 | 14,380-57,530 | 45 |
| Gastric cancer treatment | 49,270 | 24,640-98,540 | 46 |
|
| |||
| Indirect costs, U.S. 2007$ | |||
| Median hourly wage | 15.10 | 10.06-23.87 | 47 |
| Lost time, hours | |||
| Endoscopy or EMR | 8 | ‡ | |
| Surgery | 80 | ‡ | |
| Gastric cancer treatment | 351 | 327-376 | 48 |
|
| |||
| Quality of life | |||
| Age-related quality weight, utility | 0.782-0.928 | --- | 49 |
| Utility reductions | |||
| Endoscopy or EMR | -1 day | ||
| Gastrectomy | -2 weeks | ||
| Cancer-related quality weight | |||
| Gastric cancer | 0.49 | 0.17-0.79 | 50 |
EMR = endoscopic mucosal resection; CPT = Current Procedural Terminology; DRG = Diagnosis Related Group
*
Constant yearly probabilities identified via empirical calibration to epidemiologic data unless otherwise noted.
†
Age-specific probability.
‡
Base case indicates the range among 50 selected parameter sets used to reflect uncertainty in disease natural history.
§
Age-dependent. Varied ±50% in sensitivity analysis.
∥
Based on clinical study data for EMR treatment for early gastric cancer.
**
For sensitivity analysis, we used 0.5-times and 2-times base case value.