Work

Cost Utility Analysis of National Cancer Screening Program for Gastric Cancer in Korea: A Markov Model Analysis

Year: 2024

Type: article

Abstract: Background: Current Korean National Cancer Screening Program of gastric cancer containing Upper Gastrointestinal series (UGIs) as primary screening is in need to be evaluated since UGIs has low sensitivity and cancer survival rate. This study aimed to ascertain the most cost-effective strategy for NCSP of gastric cancer.Methods: Markov models were constructed for 24 strategies, which were combinations of 1) screening methods (upper gastrointestinal series or endoscopy vs. endoscopy-only), 2) screening intervals (one, two, and three years), and 3) upper age limit of screening (69, 74, and 79 years old; and “no limit”). Costs and utility were extracted from NCSP data, previous studies, and other public institution databases. Cost-utility analysis and sensitivity and scenario analysis were conducted.Findings: The endoscopy-only strategy with a three-year interval and an upper age limit of 69 (Strategy 9; S9) was the most cost-effective strategy with an incremental cost-utility ratio (ICUR) of 22,181,206 (won/quality-adjusted life years) over no-screening. The uncertainty was significantly small, and the non-coverage conscious sedation cost was the most sensitive variable to the outcome. As the cost of sedation increased, the ICUR of the endoscopy strategy also increased. In addition, according to the scenario analysis, as the screening rate increased, the cost gets lower in the endoscopy-only strategy (S9) compared to the current NCSP. Therefore, it is important to maintain high screening rate when alternating the strategy to S9.Interpretation: An UGIs is not cost-effective as a screening method for the NCSP. Furthermore, a three-year interval with an upper age limit of 69-years is the most cost-effective strategy. It is necessary to consider changing the NCSP system, and an appropriate screening rate should be maintained to maximize the effect of the change.Funding: This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (Grant No. 2210773-2).Declaration of Interest: Authors have nothing to disclose relevant to the manuscript.Ethical Approval: This study received IRB approval from the Cancer Prevention and Control Central Institution Review Board of the National Cancer Institute (IRB No. NCCNCS08129).

Source: Journal of Korean Medical Science

DOI: 10.3346/jkms.2025.40.e43