Nationwide gastric cancer prevention in China, 2021–2035: a decision analysis on effect, affordability and cost-effectiveness optimisation

Abstract

ObjectiveTo project future trajectories of the gastric cancer (GC) burden in China under different scenarios of GC prevention and identify strategies to improve affordability and cost-effectiveness.DesignUsing a cohort of Chinese men and women born during 1951–1980, we assumed that different prevention strategies were conducted, including eradication of Helicobacter pylori (Hp) and endoscopy screening (one-time, annual, biennial, triennial or stratified according to personal risk). We performed a literature search to identify up-to-date data and populate a Markov model to project the number of new GC cases and deaths during 2021–2035, as well as resource requirements and quality-adjusted life-years (QALYs). We examined the impacts of general (among the whole population) and targeted (high-risk population) prevention.ResultsDuring 2021–2035, 10.0 million new GC cases and 5.6 million GC deaths would occur, with 7.6%–35.5% and 6.9%–44.5%, respectively, being avoidable through various prevention strategies. Relative to the status quo, Hp eradication was a cost-saving strategy. General annual screening dominated other screening strategies, but cost more than CNY 70 000 per QALY gained (willingness-to-pay) compared with Hp eradication. Among endoscopy strategies, targeted screening resulted in 44%–49% lower cost per QALY gained over the status quo than general screening. Among high-risk population, tailoring the screening frequency according to personal risk could reduce endoscopy-related resources by 22% compared with biennial screening and by 55% compared with annual screening,ConclusionOur findings provide important input for future decision-making and investment, highlighting the need and feasibility for China to include GC prevention in its national health plans.

Cachexia Index as a Prognostic Indicator in Patients with Gastric Cancer: A Retrospective Study

“…There were about 769,000 deaths due to GC worldwide in 2020, ranking fourth for mortality of all malignancies globally [ 1 ]. Notably, China has nearly half of the new GC cases and deaths every year in the world [ 1 , 3 ], and it is estimated that about 10 million new GC cases will occur in China from 2021 to 2035, leading to about 5.6 million GC deaths [ 4 ].…”

Early detection of gastric cancer in China: progress and opportunities

“…Xia et al 17 have reported marked increases in the incremental cost-effectiveness ratio ranging between US $1343 and $3035 per quality-adjusted life-year for several screening strategies with different starting ages and frequencies, compared with no screening over a lifetime, thereby supporting the cost-effectiveness of endoscopic screening for UGI cancers in high-risk areas. Compared with the strategy of nationwide general screening, a decision analysis has further predicted that targeted screening results in 44%–49% lower costs per quality-adjusted life-year gained over daily routine care, thus suggesting the favorable cost-effectiveness of screening in a personalized approach for high-risk population subgroups 18 . Indeed, even among high-risk populations, the screening frequency must be adjusted to personal risk so that endoscopy-associated resources can be saved 18 .…”

“…Compared with the strategy of nationwide general screening, a decision analysis has further predicted that targeted screening results in 44%–49% lower costs per quality-adjusted life-year gained over daily routine care, thus suggesting the favorable cost-effectiveness of screening in a personalized approach for high-risk population subgroups 18 . Indeed, even among high-risk populations, the screening frequency must be adjusted to personal risk so that endoscopy-associated resources can be saved 18 .…”

Egg yolk antibody combined with bismuth-based quadruple therapy in Helicobacter pylori infection rescue treatment: a single-center, randomized, controlled study

“…Helicobacter pylori ( H. pylori ) was recognized as a class I carcinogen by the World Health Organization in 1994 and ranked as a high-priority bacterium in the list of the deadliest superbugs threatening human health in 2017 ( Dang and Graham, 2017 ; Mommersteeg et al, 2018 ; Tacconelli et al, 2018 ). Although the overall global prevalence of H. pylori infection is declining, the consequences should not be underestimated ( Ansari and Yamaoka, 2022 ; Wang et al, 2022 ).…”