Comparing Endoscopy and Upper Gastrointestinal X-ray for Gastric Cancer Screening in South Korea: A Cost-utility Analysis

Abstract

Background: There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. Objective: To evaluate the costeffectiveness of population-based screening for gastric cancer in South Korea by decision analysis. Methods: A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. Results: The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. Conclusions: Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.

Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

“…This finding is consistent with previous research showing improved efficacy and usefulness of endoscopy compared to UGI X-ray screening (Kim et al, 2000;Tsubono and Hisamichi, 2000). Because the cost of endoscopy examination of Korea is considerably lower than the UGI examination cost, the incremental costs of endoscopy screening were competitive in Korea (Chang et al, 2012). A previous report found that until the cost of endoscopy screening was 3-fold more than a UGI series, the endoscopy method should be the dominant strategy over UGI in Korea (Lee et al, 2010).…”

“…First, the study subjects were not a cohort group but the entire population of Korea, subjects who underwent NCSP gastric cancer screening in baseline. Although there have been a couple of reports investigating the cost-utility outcomes of gastric cancer screening, those Markov models were constructed based on a hypothetical cohort group (Gupta et al, 2011;Chang et al, 2012). Using large and absolute data from the whole population, this research could produce unconditional performance outputs of NCSP with no selection bias.…”

“…First, because it deviated from the objective of our study, the cost-effectiveness outcomes by different screening cycles were not investigated. Indeed, previous research using a simulated Markov-model suggested that annual, rather than biennial, endoscopic screening was the most cost-effective for the male population in Korea (Chang et al, 2012). The screening interval should depend on the growth rate of the cancer.…”

“…(Mansour-Ghanaei et al, 2012) The costeffectiveness of mass screenings may also vary according to the cost of the screening examination. For example, endoscopic screening costs in Korea are less than 50% of those in other countries, like Japan and Singapore (Chang et al, 2012).…”

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

“…The prognosis is generally favorable in early gastric cancers after radical surgery, with a 5-year survival rate of more than 90% (Hyung et al, 2002;Kwee et al, 2008). The proportion of early gastric cancer among all gastric cancers has increased to nearly 50% in Japan and Korea (Chang et al, 2012;Tatematsu et al, 2013). With more widespread mass screenings, as well as advances in endoscopic techniques and equipment, similar trends have been observed during the past few decades in China.…”