Economic cost-utility analysis of stage-directed gastric cancer treatment.

BACKGROUND: Gastric cancer (GC) treatment levies substantial financial burden on health services. Potentially curative surgery with or without chemotherapy is offered to patients with locoregional disease. This study aimed to examine treatment costs related to life-years gained in patients having potentially curative treatment (gastrectomy) and those receiving best supportive care (BSC). METHODS: Some 398 consecutive patients with GC were classified according to treatment modality (116 BSC, 282 gastrectomy). Cost calculations for 1 year's treatment from referral were made according to network diagnostic, staging and treatment algorithms. Primary outcome was overall survival (OS). RESULTS: GC median survival after BSC was 8 months, costing €5413, compared with gastrectomy median survival of 34 months, costing €22 753 for 1 year's treatment: cost per life-year gained €9319. Cost incurred for stage I GC was €22 434, stage II €23 498, stage III €22 445, and stage IV €22 032. Based on these values, the cost per quality adjusted life-year (QALY) for BSC for stage I GC was -€8335 stage II -€8952, stage III -€11 317, and stage IV -€25 669. CONCLUSION: Potentially curative treatment that included gastrectomy improved OS four-fold compared with BSC and was cost-effective at national thresholds of readiness to pay per QALY.

The 100 most influential manuscripts in gastric cancer: A bibliometric analysis.

BACKGROUND: Bibliometric analysis highlights the key topics and publications which have shaped the understanding and management of Gastric cancer. Here the 100 most cited manuscripts in the field of gastric cancer (GC) are analysed. METHODS: The Thomson Reuters Web of Science database with the search terms 'gastric cancer' or 'gastric carcinoma' or 'stomach cancer' or 'stomach carcinoma' or 'gastroscopy' was used to identify all English language full manuscripts for the study. The 100 most cited papers were further analysed by topic, journal, author, year and institution. RESULTS: 122,616 eligible papers were returned and the median (range) citation number was 417 (2893-299). The most cited paper (by Parsonnet) focused on H.Pylori risk and gastric cancer (2893 citations). Cancer Research published the highest number of papers (n = 13, 6901 citations) and The New England Journal of Medicine (NEJM) had the most citations (n = 8, 9358 citations). The country and year with the greatest number of publications were the USA (n = 29), and 1998 (n = 10). The most ubiquitous topic was the pathology of gastric cancer (n = 57) followed by aetiology of gastric cancer (n = 47), and basic science of gastric cancer (n = 44). CONCLUSION: The most cited manuscripts highlighted in this study describe the science related to the pathogenesis of GC including surgery and regimens that have resulted in the contemporary understanding and treatment of GC. This work provides the most influential references related to GC and serves as a guide as to what makes a citable paper.