Cost-utility and clinical impact of endoscopic screening for gastro-esophageal neoplasia in patients with head and neck neoplasms

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Aims Patients with head and neck neoplasms (HNN) are at increased risk of gastro-esophageal neoplasia (GEN) due to shared risk factors. Nevertheless, the cost-utility of endoscopic screening in this population has yet to be evaluated. Our aim was to assess the cost-effectiveness of an endoscopic screening strategy in patients with HNN in a Western country (Portugal). Methods In this prospective single-center study, HNN patients eligible for curative treatment underwent screening esophagogastroduodenoscopy (June 2020-December 2023). We assessed the frequency of GEN and associated clinical and pathological outcomes. The cost-effectiveness of synchronous endoscopic screening in these patients was evaluated from a societal perspective (Markov model). The screening strategy was deemed cost-effective if the incremental cost-effectiveness ratio (ICER) was lower than 1-3 times the Portuguese gross domestic product (GDP) per capita (24,646€). To account for uncertainty, we performed probabilistic sensitivity analysis. Results We initially evaluated 207 HNN patients. Forty-six met inclusion criteria and underwent endoscopic screening. In 10 of those (21.7%), a GEN was identified (esophageal neoplasia=5; gastric neoplasia=5). Most patients (n=9) underwent treatment with curative intent. The endoscopic screening strategy had an ICER of 39,357.8€/Quality Adjusted Life Yearsgained, being cost-effective at a willingness-to-pay threshold of two times the Portuguese GDP per capita. In probabilistic sensitivity analysis, screening displayed a 63% probability of being cost-effective considering that willingness-to-pay threshold. Conclusions An endoscopic screening program identified GEN in a fifth of HNN patients, most presenting at an early stage. The program implementation is cost-effective in Portugal. These results may be applicable to most medium/high-income Western countries. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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