ArticleFrontiers in public health2025
Cost-utility of endoscopic screening strategies for upper gastrointestinal cancer across China: a modeling study.
Article in Frontiers in public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.
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