Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, China.
Front Public Health. 2022 Aug 10;10:955120. doi: 10.3389/fpubh.2022.955120. eCollection 2022.
Current guidelines recommend the gastric cancer risk score scale (GCRSS) for screening in gastric cancer (GC) high-risk populations in China. This study aimed to estimate the clinical benefits, harms, cost, and cost-effectiveness of the GCRSS screening strategy from a Chinese healthcare system perspective.
Using a microsimulation model, we evaluated 7 screening scenarios of the GCRSS with varying starting ages. We simulated 100,000 individuals from the age of 20 for each screening scenario. The main outcomes included GC incidence reduction, number of cause-specific deaths, costs, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and benefit-to-harm ratio. Deterministic and probabilistic sensitivity analyses were done to explore the robustness of model findings.
Screening with the GCRSS strategy at the age of 40 years (40-GCRSS) provided the greatest reduction of GC incidence by 70.6%, with 7,374 GC deaths averted per 100,000 individuals and the lowest benefit-to-harm ratio of 0.392. Compared with no screening or previous less costly strategy, at a willingness-to-pay (WTP) threshold of $37,655 per QALY, the 40-GCRSS strategy was cost-effective, with ICERs of $12,586 and $29,115 per QALY, respectively. Results were robust across univariate and probabilistic sensitivity analyses. The 40-GCRSS strategy showed a 0.856 probability of being cost-effective at a $37,655 per QALY WTP threshold.
The findings suggest that the GCRSS strategy is effective and cost-effective in reducing the GC disease burden in China from a Chinese healthcare system perspective. Screening from the age of 40 would be the optimal strategy.
目前的指南建议使用胃癌风险评分量表（GCRSS）对中国胃癌（GC）高危人群进行筛查。本研究旨在从中国医疗保健系统的角度评估 GCRSS 筛查策略的临床获益、危害、成本和成本效益。
使用微观模拟模型，我们对 GCRSS 的 7 种不同起始年龄的筛查方案进行了评估。我们为每个筛查方案模拟了 10 万名 20 岁的个体。主要结果包括 GC 发病率降低、特定原因死亡人数、成本、质量调整生命年（QALY）、增量成本效益比（ICER）和效益-危害比。进行了确定性和概率敏感性分析，以探讨模型结果的稳健性。
40 岁时进行 GCRSS 筛查策略（40-GCRSS）可最大程度降低 GC 发病率，减少 70.6%，每 10 万人中有 7374 人死于 GC，效益-危害比最低，为 0.392。与不筛查或之前成本较低的策略相比，在愿意支付（WTP）阈值为 37655 美元/QALY 时，40-GCRSS 策略具有成本效益，ICER 分别为 12586 美元和 29115 美元/QALY。在单变量和概率敏感性分析中结果均稳健。在 37655 美元/QALY 的 WTP 阈值下，40-GCRSS 策略具有 0.856 的成本效益概率。
从中国医疗保健系统的角度来看，GCRSS 策略在降低中国 GC 疾病负担方面是有效且具有成本效益的。从 40 岁开始筛查将是最佳策略。
