Cost-utility and clinical impact of endoscopic screening for esophageal and gastric neoplasia in patients with head and neck neoplasms
Year: 2025
Type: article
Abstract: OBJECTIVE: Patients with head and neck neoplasms (HNN) are at an increased risk of esophageal neoplasia (EN) and gastric neoplasia (GN). We aimed to assess the clinical impact and cost-utility of endoscopic screening in this population in the Western setting. METHODS: In this single-center study HNN patients eligible for curative treatment underwent screening esophagogastroduodenoscopy. We assessed the frequency, clinical, and pathological outcomes of EN and GN. The cost-effectiveness of an annual endoscopic screening for EN was evaluated from a societal perspective, using a Markov model and probabilistic sensitivity analysis. In addition, we performed a sensitivity analysis using data on the prevalence of detected EN lesions in the four largest previous Western studies on this topic. RESULTS: Forty-six HNN patients met the inclusion criteria and underwent endoscopic screening. Six EN were detected in five patients (10.9%, 95% confidence interval: 1.9-19.9%). Additionally, five GN were detected in five patients. Most patients had early-stage EN or GN (90%) and were treated with endoscopic resection (80%). Endoscopic screening strategy had an incremental cost-effectiveness ratio of 39 357.8 €/quality-adjusted life years gained, being cost-effective at a willingness-to-pay threshold of two times the Portuguese gross domestic product per capita. In the sensitivity analysis, it remained cost-effective when considering the prevalence of EN reported in Germany, France, and Brazil. CONCLUSION: An endoscopic screening program identified EN or GN in a fifth of HNN patients, most presenting at an early stage. The program implementation appears to be cost-effective in Portugal. These results may be applicable to other medium-to-high-income Western countries.
Authors: Rui Morais, João Afonso, Nuno Sousa, Bernardo Sousa-Pinto, Diogo Libânio, Bárbara Marinho, Maria Luísa Sacramento, Mariana Simplício, Isabel Faria-Ramos, Luís Azevedo, Margarida Marques, Helena Silveira, Irene Gullo, Fátima Carneiro, João Santos-Antunes, Guilherme Macedo
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4410339343