Cost-Effective Endoscopic Screening Strategies for Asymptomatic Gastric Cancer

In Japan, biennial esophagogastroduodenoscopy (EGD) screening for gastric cancer (GC) has been implemented for adults aged ≥50 years as part of a population-based screening program. This approach has facilitated early GC detection and demonstrated individual-level benefits. However, due to a generational decline in Helicobacter pylori infection, a reduction in the long-term effectiveness of this strategy is anticipated. Given the allocation of national resources, a cost-effectiveness evaluation is essential.

As GC prevalence declines in the target population, the cost-effectiveness of existing screening practices may diminish. Mathematical simulation models are commonly employed to assess the comparative effectiveness and cost-effectiveness of various cancer screening strategies. Microsimulation models, which track individual-level outcomes, are utilized to evaluate person-level effects. By contrast, macrosimulation models - such as Markov and decision tree models - are used to assess population-level outcomes.

Nine studies have compared different EGD screening strategies. These studies support the effectiveness of biennial screening in high-risk countries. In low- to intermediate-risk countries - and among lower risk populations within high-risk countries - extending the screening interval to ≥3 years appears reasonable. Additionally, strategies incorporating risk stratification using alternative modalities, such as serological tests, are more cost-effective. Continued discussion is necessary to optimize the EGD screening approach.