Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

Abstract

Background: Although screening is necessary where gastric cancer is particularly common in Asia, the performance outcomes of mass screening programs have remained unclear. This study was conducted to evaluate cost-effectiveness outcomes of the national cancer screening program (NCSP) for gastric cancer in South Korea. Materials and Methods: People aged 40 years or over during 2002-2003 (baseline) were the target population. Screening recipients and patients diagnosed with gastric cancers were identified using the NCSP and Korea Central Cancer Registry databases. Clinical outcomes were measured in terms of mortality and life-years saved (LYS) of gastric cancer patients during 7 years based on merged data from the Korean National Health Insurance Corporation and National Statistical Office. We considered direct, indirect, and productivity-loss costs associated with screening attendance. Incremental cost-effectiveness ratio (ICER) estimates were produced according to screening method, sex, and age group compared to non-screening. Results: The age-adjusted ICER for survival was 260,201,000-371,011,000 Korean Won (KW; 1USD=1,088 KW) for the upper-gastrointestinal (UGI) tract over non-screening. Endoscopy ICERs were lower (119,099,000-178,700,000 KW/survival) than UGI. To increase 1 life-year, additional costs of approximately 14,466,000-15,014,000 KW and 8,817,000-9,755,000 KW were required for UGI and endoscopy, respectively. Endoscopy was the most cost-effective strategy for males and females. With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. For males, an upper limit of age 75 or 80 years could be considered. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective. Conclusion: Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.

Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution

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Gastric Cancer in Asian American Populations: a Neglected Health Disparity

“…Gastric cancer screening was implemented in Korea during 1999 as part of the national cancer screening program Choi et al, 2012;Shin and Lee, 2012;Cho et al, 2013;Kim et al, 2013). Screening every two years is recommended for people ages 40 years and older via either gastric endoscopy or upper gastrointestinal series Choi et al, 2012).…”

Health Economics Evaluation of a Gastric Cancer Early Detection and Treatment Program in China

“…The cost of the digestive tract X-ray barium meal examination to avoid death in a patient with gastric cancer is $239155 -$341002. The cost of the gastroscope to avoid death in a patient with gastric cancer screening is $109466-164246, increasing cost of get a life year is $8104-8966 (Cho et al, 2013). The two countries' gastric cancer screening program cost is higher, is not suitable for China.…”

“…With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective (Cho et al, 2013). According to comprehensive evaluation the gastric cancer screening program at home and abroad, the sensitivity and specificity of the study is high (Yuan et al, 2012 ), easy, cost effective and reasonable, and also participants compliance is good.…”