Chang Hoo-Sun, Park Eun-Cheol, Chung Woojin, Nam Chung Mo, Choi Kui Son, Cho Eun, Cho Woo-Hyun
Department of Preventive Medicine, Yonsei University, Seoul, Korea.
Asian Pac J Cancer Prev. 2012;13(6):2721-8. doi: 10.7314/apjcp.2012.13.6.2721.
There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population.
To evaluate the cost- effectiveness of population-based screening for gastric cancer in South Korea by decision analysis.
A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio.
The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources.
Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.
在普通人群中，评估使用内窥镜检查或上消化道X线进行胃癌筛查的成本效益的数据有限。
通过决策分析评估韩国基于人群的胃癌筛查的成本效益。
为30岁及以上的健康成年人构建了一个随时间变化的胃癌马尔可夫模型，并进行了确定性敏感性分析。进行了多种策略的成本效用分析，以比较13种不同筛查方案在以下入选标准方面的成本和效果：筛查开始年龄、筛查间隔和筛查方法。主要结局指标是增量成本效益比。
结果显示，50至80岁男性每年进行内窥镜筛查是最具成本效益的。在女性中，50至80岁每两年进行一次内窥镜筛查被计算为12种筛查方案中最具成本效益的策略。最具成本效益的筛查策略可能会根据筛查成本和筛查时癌症分期的分布情况进行调整。局限性在于有效性数据来自已发表的资料。
根据世界卫生组织的建议，以韩国国内生产总值（2008年）为基础，采用每质量调整生命年19,162美元的阈值，50岁开始进行内窥镜胃癌筛查在韩国人群中具有很高的成本效益。国家对胃癌筛查的建议应考虑筛查开始年龄、筛查间隔和筛查方式。
