Cost-Effectiveness Analysis of Screening for Gastric Cancer in Japan.

Abstract

Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The costeffectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.cost-effectiveness analysis ; gastric cancer screening ; simulation study Our previous cost-effectiveness analysis on colorectal cancer screening (Tsuji et al. 1991) showed that the combination of the two-day immunological fecal occult blood test (FOBT) and total colonoscopy (TCF) was the best cost-effective strategy in Japan. The cost per life-year saved by this screening method amounted 3,308.5 (x 103) yen for males and 4,130.3 (x 103) yen for females.These findings lead us to question whether or not a public financed program for colorectal cancer screening should be initiated, and whether the program would be economically worthy of sponsoring. Unlike a cost-benefit analysis, a costeffectiveness analysis does not judge the "absolute" value of a program, but provides information on its "relative" value in comparison with other programs. Therefore, to answer the above questions, it is necessary to compare the cost-

Cost-effectiveness of coronary artery disease screening in asymptomatic patients with type 2 diabetes and other atherogenic risk factors in Japan: Factors influencing on international application of evidence-based guidelines

“…However, the actual criteria for acceptable cost-effectiveness ratio appear to depend strongly on social circumstances, so that the $50,000/QALY threshold should not be necessarily applied to our results. The incremental cost-effectiveness ratio for gastric cancer screening in men was $5800 per life expectancy (LE), and in women it was $14,800/LE [51]; it was found to be $26,800/ LE for breast cancer screening by physical examination and mammography [52]. These screening programs have already been accepted and implemented across Japan for many years, so that the incremental cost-effectiveness of CAD screening seems to be within the acceptable range.…”

Cost-effectiveness of pravastatin for primary prevention of coronary artery disease in Japan

“…The cost-effectiveness of pravastatin therapy should be compared with that of currently accepted therapeutic or diagnostic interventions. The marginal cost-effectiveness ratio of screening in Japan has been estimated to be 0.7 million yen/life expectancy (LE) in men and 1.8 million yen/LE in women for gastric cancer [42], 2 million yen/LE for colorectal cancer [43], 3.2 million yen/QALY for physical examination and mammography to detect breast cancer [44], 0.88 yen/QALY for Pap smears to detect cervical cancer [45], and 5.4 million yen/ QALY for screening of osteoporosis [46], all adjusted to 2002 prices. These screening programs have been already accepted by Japanese society.…”

Screening for gastric cancer in Japan

“…Studies also examined the economic efficiency and the safety of the screening. The cost-effectiveness of the program was shown to be better than that of screening for colorectal cancer by fecal occult blood testing [49]. No increased risk of developing leukemia following radiation exposure by photofluorography was observed [50,51].…”