Is Endoscopic Surveillance of Gastric Ulcers Cost-Effective?

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.