Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study

BMC Medicine

Shuhei Nomura¹  Chi Yan Leung²  Hsi-Lan Huang²  Kenji Shibuya³  Chin Hur⁴  Kota Katanoda⁵  Eiko Saito⁵  Chung Yin Kong⁶ 

[1] Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan;Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan;Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan;Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan;University Institute for Population Health, King’s College London, London, UK;Department of Medicine, Columbia University Irving Medical Center, New York City, USA;Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA;Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan;Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA;Department of Radiology, Harvard Medical School, Boston, MA, USA;

关键词: Microsimulation;    Cost-effectiveness analysis;    Gastric cancer;    Cancer screening;   

DOI  :  10.1186/s12916-020-01729-0

来源: Springer

【 摘 要 】

BackgroundA national endoscopic screening program for gastric cancer was rolled out in Japan in 2015. We used a microsimulation model to estimate the cost-effectiveness of current screening guidelines and alternative screening strategies in Japan.MethodsWe developed a microsimulation model that simulated a virtual population corresponding to the Japanese population in risk factor profile and life expectancy. We evaluated 15 endoscopic screening scenarios with various starting ages, stopping ages, and screening intervals. The primary outcomes were quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio. Cost-effective screening strategies were determined using a willingness-to-pay threshold of $50,000 per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were done to explore model uncertainty.ResultsUsing the threshold of $50,000 per QALY, a triennial screening program for individuals aged 50 to 75 years was the cost-effective strategy, with an incremental cost-effectiveness ratio of $45,665. Compared with no endoscopic screening, this strategy is predicted to prevent 63% of gastric cancer mortality and confer 27.2 QALYs gained per 1000 individuals over a lifetime period. Current screening guidelines were not on the cost-effectiveness efficient frontier. The results were robust on one-way sensitivity analyses and probabilistic sensitivity analysis.ConclusionsThis modeling study suggests that the endoscopic screening program in Japan would be cost-effective when implemented between age 50 and 75 years, with the screening repeated every 3 years. These findings underscore the need for further evaluation of the current gastric cancer screening recommendations.

【 授权许可】

CC BY