[Epidemiological Analysis and Economic Burden of Gastric and Gastroesophageal Junction Neoplasms in Italy]

OBJECTIVES: To estimate the epidemiological distribution and economic impact of gastric and gastroesophageal junction neoplasms in Italy. METHODS: Retrospective transversal and longitudinal analyses were conducted using the Italian Hospital Discharge Records from 2010 to 2019, and the administrative databases of the Umbria 2 Local Health Unit for the period 2014-2018. Patients were stratified by disease stage. Incidence, prevalence, in-hospital mortality, and progression patterns were estimated. Cost analyses included hospitalizations, outpatient specialist services, and pharmaceutical expenditures, based on regional tariffs. The methodology and findings were validated through two structured discussions with Key Opinion Leaders from northern, central, and southern Italy. RESULTS: The national incidence and mortality decreased over time, while prevalence showed a peak in 2017. A marked regional variability in hospitalization rates was noted, reflecting differences in healthcare practices rather than underlying epidemiology. The trend toward decreased mortality was not confirmed by the analysis in Umbria 2 Health Authority, which accounted also for non-hospital mortality. Average annual per-patient costs borne by the Italian National Health Service (NHS) were & euro;12,797, & euro;18,505, and & euro;15,173 for localized, locally advanced, and metastatic disease, respectively. Hospitalization costs accounted for over 88% of expenses. One-year mortality reached 74% in the metastatic group. As the period considered predates the widespread adoption of high-cost targeted therapies and immunotherapies, current costs are likely underestimated. CONCLUSIONS: Gastric and gastroesophageal junction cancers remain a significant burden for the Italian NHS in terms of both clinical outcomes and healthcare spending. This study offers an integrated national and regional perspective on the real-world impact of these diseases, reinforcing the need for improved data integration, early detection strategies, and resource planning tailored to future therapeutic developments.