Cost-utility of comprehensive endoscopic screening strategies for upper gastrointestinal cancer in rural China

Abstract

Background

Endoscopic screening for upper gastrointestinal cancer (UGC) has been proven to be effective, but there is little evidence of its cost-utility regarding comprehensive screening strategies. We aimed to assess the cost-utility of various endoscopic screening strategies for UGC within the Chinese healthcare system.

Methods

A Markov model was constructed to assess the cost-utility of 40 screening strategies consisting of different screening starting ages (40, 45, 50, or 55 years old), screening frequencies (once per lifetime and every year, 2 years, 5 years, 10 years and 15 years), and follow-up or not. Model parameters were estimated based on our survey data, public surveillance data, and published literature. The primary outcome was the incremental cost-utility ratios (ICUR, incremental health care costs per quality-adjusted life-year [QALY] gained). Deterministic and probabilistic sensitivity analyses were performed to examine key parameter uncertainty.

Findings

The cost-utility analysis identified 7 strategies as the dominant strategies given 1 times per capita GDP (¥70653/$9821.69) of Shandong province in China in 2019. Compared with no screening, all dominant strategies were associated with improved ICUR by CNY 12 095.60 to ¥31 456.29 per QALY. Compared with neighboring strategy, all dominant strategies were associated with improved ICUR by CNY 12 095.62 to ¥66 764.06 per QALY. The y40-nf-il would be the most cost-utility strategy, with probabilities of 42% to 95% at 1-3 times the per capita GDP. At a WTP lower than 1 times per capita GDP, the probability of the y40-nf-i2 strategy being more cost-utility is highest. Findings were robust in all sensitivity analyses.

Interpretation

Combined endoscopic screening for UGC appears cost-utility in the Chinese healthcare system. Screening at the age of 40, conducting it annually and without follow-up, would be the optimal strategy. However, in areas with economic constraints and limited resources, modifying this optimal strategy to be implemented every 2 years could enhance cost-utility. Those findings would be useful for the development of policies targeting the prevention and control of UGC in China.