Cost-utility of endoscopic screening strategies for upper gastrointestinal cancer across China: a modeling study

Endoscopic screening for upper gastrointestinal cancer (UGC) is effective, but it's cost-utility across comprehensive strategies remains unclear. We aimed to assess the cost-utility of various endoscopic screening strategies for UGC within the Chinese health care system.

This study assessed the cost-utility of 40 endoscopic screening strategies using a Markov model. Strategies varied by starting ages (40, 45, 50, or 55 years), screening frequencies (once per lifetime, every 1, 2, 5, 10, or 15 years), and follow-up options. 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). Deterministic and probabilistic sensitivity analyses were performed to examine key parameters uncertainty.

Seven strategies were identified as the dominant strategies given one-time per capita GDP (¥70,653) of Shandong province in China in 2019. Compared with no screening, all dominant strategies were associated with improved ICUR by CNY ¥12 095.60-31 456.29 per quality-adjusted life years (QALY). Compared with the neighboring strategy, all dominant strategies were associated with improved ICUR by CNY ¥12 095.6266 764.06 per QALY. The y40-nf-il would be the most cost-utility strategy, with probabilities of 42%-95% at 1-3 times the per capita GDP. Findings were robust in all sensitivity analysis.

Comprehensive endoscopic screening strategies for UGC are cost-effective within the Chinese healthcare system. Annual screening starting at age 40 without follow-up emerges as the optimal approach, offering valuable evidence to guide policy development for UGC prevention and control in China.