ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1643171
This article is part of the Research TopicHealth Economic Evaluation in Cancer Prevention and ControlView all articles
Cost-utility of Endoscopic Screening Strategies for Upper Gastrointestinal Cancer across China: a modelling study
Provisionally accepted
- 1Shandong University, Jinan, China
- 2Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Introduction: Endoscopic screening for upper gastrointestinal cancer (UGC) is effective, but its cost-utility across comprehensive strategies remains unclear. We aimed to assess the cost-utility of various endoscopic screening strategies for UGC within the Chinese health care system. Methods: This study assessed the cost-utility of 40 endoscopic screening strategies using a Markov model. Strategies varied by starting ages (40, 45, 50, or 55 years), screening frequencies (once per lifetime, every 1, 2, 5, 10, or 15 years), and follow-up options. Model parameters were estimated based on our survey data, public surveillance data and published literature. The primary outcome was the incremental cost-utility ratios (ICUR). Deterministic and probabilistic sensitivity analyses were performed to examine key parameters uncertainty. Results: Seven strategies were identified as the dominant strategies given one-time per capita GDP (¥70653) of Shandong province in China in 2019. Compared with no screening, all dominant strategies were associated with improved ICUR by CNY ¥12 095·60 to ¥31 456·29 per QALY. Compared with the neighboring strategy, all dominant strategies were associated with improved ICUR by CNY ¥12 095·62 to ¥66 764·06 per QALY. The y40-nf-il would be the most cost-utility strategy, with probabilities of 42% to 95% at 1-3 times the per capita GDP. Findings were robust in all sensitivity analysis. Conclusions: Comprehensive endoscopic screening strategies for UGC are cost-effective within the Chinese healthcare system. Annual screening starting at age 40 without follow-up emerges as the optimal approach, offering valuable evidence to guide policy development for UGC prevention and control in China.
Keywords: Cost-utility, Upper gastrointestinal cancer, Endoscopic screening, Comprehensive Screening Strategies, Markov model
Received: 08 Jun 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 Liu, Li, Wang, Shang, Zhang and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Nan Zhang, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Qiang Sun, Shandong University, Jinan, China
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