Table 2.
Cost-effectiveness results for select strategies for 50-year old men with dysplasia or intestinal metaplasia*
| Strategy† | Reduction in lifetime gastric cancer risk‡, % |
Undiscounted life expectancy, years |
Discounted QALE, years |
Incremental discounted QALE, days |
Discounted lifetime costs§, $ |
Incremental discounted costs, $ |
ICER, $ per QALY |
|
|---|---|---|---|---|---|---|---|---|
| Dysplasia | No treatment or surveillance | -- | 28.0839 | 15.1663 | -- | 1,930 | -- | -- |
| EMR with surveillance every 10 y | 89.2 (87.4-90.0) |
28.4888 | 15.3273 | 58.7 | 4,924 | 2995 | 18,600 | |
| EMR with surveillance every 5 y | 92.4 (91.3-92.9) |
28.5093 | 15.3358 | 3.1 | 5,102 | 177 | 20,900 | |
| EMR with surveillance every 1 y | 94.7 (94.4-94.7) |
28.5238 | 15.3416 | 2.1 | 5,333 | 231 | 39,800 | |
| EMR with surveillance every 1 y and post-treatment surveillance every 10 y |
97.9 (97.2-98.2) |
28.5314 | 15.3429 | 0.5 | 6,754 | 1,422 | 1,048,000 | |
|
| ||||||||
|
| ||||||||
| Intestinal metaplasia |
No treatment or surveillance | -- | 28.7110 | 15.4531 | -- | 262.04 | -- | -- |
| EMR with surveillance every 10 y | 59.8 (52.0-63.5) |
28.7303 | 15.4577 | 1.7 | 2756.78 | 2495 | 544,500 | |
| EMR with surveillance every 10 y and post-treatment surveillance every 10 y |
60.8 (54.4-66.5) |
28.7305 | 15.4577 | 0.0 | 2808.64 | 52 | 25,930,000 | |
*
Strategies shown are those that remained after excluding strategies that were more costly and less effective (i.e. strongly dominated) or less costly and less cost-effective (i.e. weakly dominated) than an alternative strategy. QALE = quality-adjusted life expectancy; ICER = incremental cost-effectiveness ratio; QALY = quality-adjusted life year; y = years.
†
No surveillance assumes cases identified only via symptoms.
‡
Range represents reduction among selected parameter sets.
§
Costs are expressed in discounted 2007 U.S. dollars.