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Clinical Benefit and Cost Effectiveness of Risk-Stratified Gastric Cancer Screening Strategies in China: A Modeling Study

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Abstract

Background and Objective

A new gastric cancer screening scoring system (NGCS) strategy was recommended for the early gastric cancer (GC) screening process in China. The current study aimed to assess the clinical benefits and the cost effectiveness of the NGCS strategy in GC high-risk areas of China from a societal perspective.

Methods

A Markov microsimulation model was developed to evaluate 30 alternative screening strategies with varying initiation age, including the NGCS strategy, the modified NGCS strategy, and the endoscopic screening strategy with various screening intervals. The primary outcomes included GC mortality, number of endoscopies, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Cost estimates were reported in 2021 USD (US$) and both costs and benefits were discounted at 5% annually. Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty.

Results

Screening with the NGCS strategy from age 40 years (40-NGCS) reduced the GC incidence by 86.4%, which provided the greatest benefit across strategies. Compared with all strategies, at a willingness-to pay threshold of US$17,922 per QALY, the 40-NGCS strategy was a leading cost-effective strategy, with an ICER of US$15,668 per QALY. Results were robust in univariate and probabilistic sensitivity analyses. The probability of the 40-NGCS strategy being cost effective was 0.863.

Conclusions

The 40-NGCS strategy was an effective and cost-effective strategy to reduce GC incidence and mortality in China. The findings provide important evidence for decision makers to formulate and optimize targeted approaches for GC prevention and control policies in China.

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Acknowledgements

We are grateful to the High Performance Computing Center of Central South University for partial support of this work.

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Authors and Affiliations

  1. Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China

    Shuxia Qin, Chongqing Tan, Xia Luo, Lidan Yi, Liubao Peng, Meiyu Wu, Ye Peng, Liting Wang & Xiaomin Wan

  2. Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China

    Xuehong Wang

  3. Xiangya Nursing School, Central South University, Changsha, 410013, Hunan, China

    Sini Li

  4. Faculty of Medicine, Dentistry and Health, School of Health and Related Research, University of Sheffield, Sheffield, UK

    Sini Li

  5. PET-CT Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China

    Xiaohui Zeng

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  1. Shuxia Qin
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Corresponding author

Correspondence to Xiaomin Wan.

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Funding

This work was supported by a Grant from the National Natural Science Foundation of China (Grant number 71874209, 82073818); the research project of the Health Commission of Hunan province (Grant number 202113050283); and the Postgraduate Scientific Research Innovation Project of Hunan Province (Project No. CX20210350). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

All authors declare that they have no conflict of interest.

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Availability of data and material

All datasets presented in this study are included in the article/Supplementary Material.

Code availability

The code associated with this study is proprietary.

Author contributions

SXQ, XHW, XMW, CQT, XHZ conceived and designed the study. SXQ, XMW, XHW, SNL, XL, LDY, LBP, MYW, YP, LTW developed the economic model, collected the data, performed the analyses, interpreted the results. CQT, XHZ, XHW supervised the analyses. SXQ, XMW drafted and critically revised the manuscript for important intellectual content and approved the version to be published. All authors had full access to all the data and take responsibility for the integrity of the data and reviewed and approved the final version.

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Qin, S., Wang, X., Li, S. et al. Clinical Benefit and Cost Effectiveness of Risk-Stratified Gastric Cancer Screening Strategies in China: A Modeling Study. PharmacoEconomics 40, 725–737 (2022). https://doi.org/10.1007/s40273-022-01160-8

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