Abstract：
OBJECTIVE: Periodic endoscopic screening for gastric cancer (GC) is widely performed in East Asia; however, the optimal screening strategy remains unclear. This study aimed to determine the most cost-effective endoscopic screening strategy for the detection and treatment of GC in a cohort with a low Helicobacter pylori prevalence.
METHODS: The following data were retrospectively extracted from participants who received screening endoscopy between April 2019 and March 2023: age, H. pylori infection status, presence of intestinal metaplasia, pathological diagnosis of GC, and the interval between the most recent endoscopies. A Markov state transition model was constructed based on the cohort data. The cost-effectiveness of 15 strategies with different starting ages (40/50/60 years) and screening intervals (1/2/3/4/5 years) was compared. The net monetary benefit (NMB) and incremental cost-effectiveness ratio (ICER) of quality-adjusted life-years gained by treatment were used as outcomes.
RESULTS: A simulation model was constructed based on the cohort data of 94 137 participants (mean age 54.5 years, males 57.9%; 74.4% H. pylori-naïve, 94.2% intestinal metaplasia-negative). The results of the base-case analysis showed that the screening strategy of 4-year intervals starting at the age of 40 years had the highest NMB (97 401 578 yen). In both the Monte Carlo simulation and one-way sensitivity analysis with a varying probability of H. pylori infection status transition, the ICER was superior in the screening strategy every 4 years, starting at age 40 years.
CONCLUSIONS: Our simulation showed that endoscopic screening at 4-year intervals starting at the age of 40 years was the most cost-effective method.
METHODS: The following data were retrospectively extracted from participants who received screening endoscopy between April 2019 and March 2023: age, H. pylori infection status, presence of intestinal metaplasia, pathological diagnosis of GC, and the interval between the most recent endoscopies. A Markov state transition model was constructed based on the cohort data. The cost-effectiveness of 15 strategies with different starting ages (40/50/60 years) and screening intervals (1/2/3/4/5 years) was compared. The net monetary benefit (NMB) and incremental cost-effectiveness ratio (ICER) of quality-adjusted life-years gained by treatment were used as outcomes.
RESULTS: A simulation model was constructed based on the cohort data of 94 137 participants (mean age 54.5 years, males 57.9%; 74.4% H. pylori-naïve, 94.2% intestinal metaplasia-negative). The results of the base-case analysis showed that the screening strategy of 4-year intervals starting at the age of 40 years had the highest NMB (97 401 578 yen). In both the Monte Carlo simulation and one-way sensitivity analysis with a varying probability of H. pylori infection status transition, the ICER was superior in the screening strategy every 4 years, starting at age 40 years.
CONCLUSIONS: Our simulation showed that endoscopic screening at 4-year intervals starting at the age of 40 years was the most cost-effective method.
摘要：
目的：在东亚广泛进行胃癌（GC）的定期内镜筛查；然而，最佳筛查策略尚不清楚.这项研究旨在确定在幽门螺杆菌患病率较低的队列中检测和治疗GC的最具成本效益的内镜筛查策略。
方法：从2019年4月至2023年3月接受筛查内窥镜检查的参与者中回顾性提取以下数据：年龄，幽门螺杆菌感染状态，肠上皮化生的存在，GC的病理诊断，和最近的内窥镜检查之间的间隔。基于队列数据构建了马尔可夫状态转移模型。比较了15种不同起始年龄（40/50/60岁）和筛查间隔（1/2/3/4/5年）的策略的成本效益。通过治疗获得的质量调整生命年的净货币收益（NMB）和增量成本效益比（ICER）被用作结果。
结果：根据94137名参与者的队列数据构建了一个模拟模型（平均年龄54.5岁，男性57.9%；74.4%幽门螺杆菌-天真的，94.2%肠上皮化生阴性)。基本案例分析的结果表明，从40岁开始的4年间隔的筛查策略具有最高的NMB（97401578日元）。在蒙特卡罗模拟和单向敏感性分析中，幽门螺杆菌感染状态转变的概率不同，ICER每4年在筛查策略上表现优异，从40岁开始。
结论：我们的模拟显示，从40岁开始每隔4年进行内镜筛查是最具成本效益的方法。
方法：从2019年4月至2023年3月接受筛查内窥镜检查的参与者中回顾性提取以下数据：年龄，幽门螺杆菌感染状态，肠上皮化生的存在，GC的病理诊断，和最近的内窥镜检查之间的间隔。基于队列数据构建了马尔可夫状态转移模型。比较了15种不同起始年龄（40/50/60岁）和筛查间隔（1/2/3/4/5年）的策略的成本效益。通过治疗获得的质量调整生命年的净货币收益（NMB）和增量成本效益比（ICER）被用作结果。
结果：根据94137名参与者的队列数据构建了一个模拟模型（平均年龄54.5岁，男性57.9%；74.4%幽门螺杆菌-天真的，94.2%肠上皮化生阴性)。基本案例分析的结果表明，从40岁开始的4年间隔的筛查策略具有最高的NMB（97401578日元）。在蒙特卡罗模拟和单向敏感性分析中，幽门螺杆菌感染状态转变的概率不同，ICER每4年在筛查策略上表现优异，从40岁开始。
结论：我们的模拟显示，从40岁开始每隔4年进行内镜筛查是最具成本效益的方法。
