ArticleClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2026
The Cost-Effectiveness of Gastric Cancer Screening and Surveillance Among Average-Risk and Risk-Stratified Populations.
Article in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Prevalence of Gastric Intestinal Metaplasia Among Patients with Active Helicobacter Pylori Infection Served by a Safety-Net Healthcare System.Digestive diseases and sciences · 2026Article
- Machine learning-based gastric cancer risk prediction in an asymptomatic screening population: a retrospective cohort study.Journal of gastrointestinal oncology · 2026Article
- Coding Gaps and Missed Opportunities: How Billing Practices May Improve Gastric Cancer Detection in the United States.ACG case reports journal · 2026Article
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Authors and funding
11 authors.
Funding
Abstract
BACKGROUND &
aimsGuidelines cite certain risk factors for gastric cancer (GC) as an indication for surveillance of incidentally diagnosed gastric intestinal metaplasia (IM); however, guidance on risk thresholds for routine IM screening is lacking. Cost-saving options in average-risk populations, such as bundling endoscopy with colonoscopy for colorectal cancer screening, have not been directly explored. We aimed to assess effectiveness and cost-effectiveness of screening for GC among average-risk and risk-stratified populations.
methodsMarkov models of the natural history of GC were developed to compare standalone and bundled screening and surveillance strategies with esophagogastroduodenoscopy (EGD) in average-risk individuals, and individuals risk-stratified based on family history of GC, immigrant status, and race/ethnicity. The primary outcomes were total cost, quality-adjusted life-years gained (QALYGs), and incremental cost-effectiveness ratios (ICERs). Secondary outcomes were GC incidence, mortality, and unadjusted life-years gained.
resultsScreening EGD starting at age 50 with surveillance every 5 years if IM is diagnosed was cost-effective in Asian individuals (ICER, $83,600/QALYG), and starting at age 55 was cost-effective in Black individuals (ICER, $99,500/QALYG), Hispanic individuals (ICER, $78,700/QALYG), those with a family history of GC (ICER, $76,200/QALYG), and high-risk immigrants (ICER, $95,900/QALYG). Standalone EGD screening was not cost-effective in average-risk individuals, but bundling endoscopy with colonoscopy at age 45 with surveillance for IM every 5 years was cost-effective (ICER, $87,000/QALYG).
conclusionsTargeted screening in high-risk individuals for GC should be considered in the United States. Combining upper and lower endoscopy may make one-time GC screening and risk-stratified surveillance feasible for the general population. Prospective studies are needed to validate potential benefits of preventative interventions.
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