Are we lacking economic evaluations in gastric cancer treatment

The rapid evolution of gastric cancer treatment in the face of escalating costs mandates thorough cost-effectiveness analyses to optimally direct future research and decision making. Relative to other cancer sites, the literature lacks high-quality economic evaluations to supplement clinical efficacy and effectiveness studies. As the fourth most commonly diagnosed cancer and the third leading cause of cancer-related death [1], gastric cancer is a major clinical and financial burden. Yet, very few estimations and assessments of overall costs of existing treatment methods or evaluations of cost effectiveness have been performed and fewer still meet current standards of high-quality methodology. Existing reports are often far from transparent, and very few studies present their findings according to established guidelines for the reporting of health economic data [2]. Furthermore, the few studies that have examined the overall costs of a gastric cancer diagnosis and treatment have determined that it is one of the most expensive cancers to treat on a per-patient basis [3, 4]. In the last 30 years, fewer than 30 papers have been published in English attempting to assess the costs of a gastric cancer diagnosis or explicitly compare the costs and benefits of treatment alternatives. In comparison, using the MeSH heading ‘‘Costs and Cost Analysis’’ in MEDLINE, over 300 review articles are identified for breast cancer, over 300 review articles identified for colorectal cancer, and over 100 review articles for prostate cancer; thus indicating that enough primary literature exists to generate these numerous reviews. In addition to the scientific literature, rigorous health technology assessments for new drugs and technologies are more commonly performed by government regulatory bodies such as the National Institute for Health and Care Excellence (NICE) and published as peer-reviewed reports. Searching the NICE guidance website uncovered an additional six technology appraisals since 2004, and one intervention appraisal [5]. As a clear disparity exists for economic evaluations for gastric cancer, we do not have an evidence-based understanding of how these costs are accumulated, or a comparative ratio of costs to benefits of commonly used treatment options to guide decision making. Few studies published in the last 20 years come from North America or Europe [3, 4, 6–9]. The majority of work evaluating the economic impact of gastric cancer and its various treatment strategies was performed in Asia, where the incidence of disease is much higher, and a larger proportion of early curative gastric cancer is diagnosed and A. L. Mahar A. Johnson Department of Public Health Sciences, Queen’s University, Kingston, Canada