Cost-effectiveness analysis of multiple gastric cancer screening strategies in Northwest China based on a population program: a Markov modeling study

Background: Gastric cancer remains a significant global health problem and poses heavy public health and economic burdens on the health system. This study aimed to compare cost-effectiveness among multiple gastric cancer screening strategies and identify the most cost-effective one in Northwest China based on a population-based cohort study using a Markov model. Methods Based on the real-world data, a Markov model was developed to evaluate the cost-effectiveness of 21 screening strategies with various screening methods, starting ages, stopping ages, and screening intervals versus no screening for a high-risk gastric cancer population in China. The primary outcomes were quality-adjusted life-years (QALY), costs, effectiveness, and the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses explored uncertainty. Results Our baseline model of annual endoscopic screening for individuals aged 40 to 75 years was the cost-effective strategy, with an ICER of US$ 545.79/QALY compared with no screening. In the scenario analysis, only the H. pylori screen-and-treat from 20 years strategy was non-dominated, with an ICER of US$ 157.41/QALY, and all other systems were dominated (providing less benefit but higher cost). Using the US$ 15,000 per QALY, all selected screening strategies for gastric cancer were cost-effective in the high-risk region of Northwest China. One-way and probabilistic sensitivity analyses demonstrated that the results are robust. Conclusions This modelling study provides evidence for the cost-effectiveness of an endoscopic screening program for gastric cancer in the high-risk region of China. Primary prevention appears more cost-effective than secondary prevention strategies. If primary prevention is not an option, secondary prevention strategies should be considered. All selected screening strategies seem to be cost-effective in the high-incidence area of Northwest China.