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Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia.
J Gastroenterol Hepatol. 2007 Oct; 22(10):1594-604.JG

Abstract

BACKGROUND

The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen.

METHODS

A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed.

RESULTS

A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia.

CONCLUSIONS

The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer.

Authors+Show Affiliations

Department of Gastroenterology, Portuguese Oncology Institute, Porto, Portugal. mario@med.up.ptNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17845687

Citation

Dinis-Ribeiro, Mário, et al. "Feasibility and Cost-effectiveness of Using Magnification Chromoendoscopy and Pepsinogen Serum Levels for the Follow-up of Patients With Atrophic Chronic Gastritis and Intestinal Metaplasia." Journal of Gastroenterology and Hepatology, vol. 22, no. 10, 2007, pp. 1594-604.
Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, et al. Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia. J Gastroenterol Hepatol. 2007;22(10):1594-604.
Dinis-Ribeiro, M., da Costa-Pereira, A., Lopes, C., & Moreira-Dias, L. (2007). Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia. Journal of Gastroenterology and Hepatology, 22(10), 1594-604.
Dinis-Ribeiro M, et al. Feasibility and Cost-effectiveness of Using Magnification Chromoendoscopy and Pepsinogen Serum Levels for the Follow-up of Patients With Atrophic Chronic Gastritis and Intestinal Metaplasia. J Gastroenterol Hepatol. 2007;22(10):1594-604. PubMed PMID: 17845687.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility and cost-effectiveness of using magnification chromoendoscopy and pepsinogen serum levels for the follow-up of patients with atrophic chronic gastritis and intestinal metaplasia. AU - Dinis-Ribeiro,Mário, AU - da Costa-Pereira,Altamiro, AU - Lopes,Carlos, AU - Moreira-Dias,Luís, PY - 2007/9/12/pubmed PY - 2008/1/25/medline PY - 2007/9/12/entrez SP - 1594 EP - 604 JF - Journal of gastroenterology and hepatology JO - J Gastroenterol Hepatol VL - 22 IS - 10 N2 - BACKGROUND: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia may lead to early diagnosis of gastric cancer. However, to-date no cost-effective model has been proposed. Improved endoscopic examination using magnification chromoendoscopy together with non-invasive functional assessment with pepsinogen serum levels are accurate in the diagnosis of intestinal metaplasia (extension) and minute dysplastic lesions. The aim of this study was to assess the feasibility and cost-effectiveness of a follow-up model for patients with atrophic chronic gastritis and intestinal metaplasia based on gastric mucosal status using magnification chromoendoscopy and pepsinogen. METHODS: A cohort of patients with lesions as severe as atrophic chronic gastritis were followed-up according to a standardized protocol using magnification chromoendoscopy with methylene blue and measurement of serum pepsinogen I and II levels. A single node decision tree and Markov chain modeling were used to define cost-effectiveness of this follow-up model versus its absence. Transition rates were considered time-independent and calculated using primary data following cohort data analysis. Costs, quality of life and survival were estimated based on published data and extensive sensitivity analysis was performed. RESULTS: A total of 100 patients were successfully followed-up over 3 years. Seven cases of dysplasia were diagnosed during follow-up, all among patients with incomplete intestinal metaplasia at baseline, six of whom had extensive (pepsinogen I to II ratio <3) incomplete intestinal metaplasia. For those individuals with atrophic chronic gastritis or complete intestinal metaplasia, a yearly measurement of pepsinogen levels or an endoscopic examination on a 3-yearly basis would cost 455 euros per quality-adjusted life year (QALY) gain. Endoscopic examination and pepsinogen serum level measurement on a yearly basis would cost 1868 euros per QALY for patients with extensive intestinal metaplasia. CONCLUSIONS: The follow-up of patients with atrophic chronic gastritis or intestinal metaplasia is both feasible and cost-effective if improved accurate endoscopic examination of gastric mucosa together with non-invasive assessment of gastric mucosal status are used to identify individuals at high-risk for development of gastric cancer. SN - 0815-9319 UR - https://www.unboundmedicine.com/medline/citation/17845687/Feasibility_and_cost_effectiveness_of_using_magnification_chromoendoscopy_and_pepsinogen_serum_levels_for_the_follow_up_of_patients_with_atrophic_chronic_gastritis_and_intestinal_metaplasia_ L2 - https://doi.org/10.1111/j.1440-1746.2007.04863.x DB - PRIME DP - Unbound Medicine ER -