Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea
Eun Cho ; Moon Hae Kang ; Eun-Cheol Park ; Jae Kwan Jun ; MiNa Suh ; Kui Son Choi
Asian Pacific Journal of Cancer Prevention, Vol.14(4) : 2533~2540, 2013
Asian Pacific Journal of Cancer Prevention
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.