[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 junctionneoplasms in Italy. METHODS: Retrospective transversal and longitudinal analyses were conducted using the Italian Hospital Discharge Recordsfrom 2010 to 2019, and the administrative databases of the Umbria 2 Local Health Unit for the period 2014–2018. Patientswere 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 regionaltariffs. The methodology and findings were validated through two structured discussions with Key Opinion Leaders fromnorthern, central, and southern Italy. RESULTS: The national incidence and mortality decreased over time, while prevalence showed a peak in 2017. A markedregional variability in hospitalization rates was noted, reflecting differences in healthcare practices rather than underlyingepidemiology. 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 HealthService (NHS) were €12,797, €18,505, and €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 theperiod considered predates the widespread adoption of high-cost targeted therapies and immunotherapies, current costs arelikely underestimated. CONCLUSIONS: Gastric and gastroesophageal junction cancers remain a significant burden for the Italian NHS in termsof both clinical outcomes and healthcare spending. This study offers an integrated national and regional perspective onthe real-world impact of these diseases, reinforcing the need for improved data integration, early detection strategies, andresource planning tailored to future therapeutic developments.