Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study
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RESEARCH ARTICLE
Open Access
Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study Hsi-Lan Huang1,2†, Chi Yan Leung1,2*†, Eiko Saito2, Kota Katanoda2, Chin Hur3,4, Chung Yin Kong4,5, Shuhei Nomura1,6,7 and Kenji Shibuya1,8
Abstract Background: A 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. Methods: We 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. Results: Using 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. Conclusions: This modeling study suggests that the endoscopic screening program in Japan would be costeffective 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. Keywords: Microsimulation, Cost-effectiveness analysis, Gastric cancer, Cancer screening
* Correspondence: [email protected] † Hsi-Lan Huang and Chi Yan Leung share co-first authorship. 1 Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan 2 Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a c
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