Gastric cancer (GC) poses notable economic and health burdens in settings where the incidence of disease is prevalent. Some countries have established early screening and treatment programs to address these challenges. The objectives of this systematic review were to summarize the cost-effectiveness of gastric cancer screening presented in the literature and to identify the critical factors that influence the cost-effectiveness of screening. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Economic evaluation studies of gastric cancer screening were reviewed from SCOPUS and PubMed. The Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) was used to assess the quality of reporting presented in the selected articles. Only primary economic evaluation studies addressing the cost-effectiveness, cost–utility, and cost–benefit of gastric cancer screening were selected. Two reviewers scrutinized the selected articles (title, abstract, and full text) to determine suitability for the systematic review based on inclusion and exclusion criteria. Authors’ consensus was relied on where disagreements arose. The main outcome measures of concern in the systematic review were cost, effectiveness (as measured by either quality-adjusted life years (QALY) or life-years saved (LYS)), and incremental cost-effectiveness ratio (ICER) of screening versus either no screening or an alternative screening method. Thirty-one studies were selected for the final review. These studies investigated the cost-effectiveness of GC screening based on either primary, secondary, or a combination of primary and secondary interventions. The main primary intervention wasHelicobacter pylori(Hp) screening with eradication, while the main secondary intervention was endoscopic screening. Cost-effectiveness was evaluated against no screening or screening using an alternative method in both observational and model-based studies. Screening was mainly cost-effective in Asian countries or their diasporas where the prevalence of GC was high. GC screening was generally not cost-effective among Western countries. GC screening can be cost-effective, but cost-effectiveness is dependent on context-specific factors, including geographical location, the prevalence of GC in the local population, and the screening tool adopted. However, there is benefit in targeting high-risk population groups in Asian countries and their diaspora for GC screening.
胃癌在疾病高发地区造成了显著的经济与健康负担。为应对这一挑战，部分国家已建立早期筛查与治疗项目。本系统综述旨在总结文献中关于胃癌筛查的成本效益，并识别影响筛查成本效益的关键因素。研究严格遵循系统综述与荟萃分析优先报告条目（PRISMA）指南，通过SCOPUS和PubMed数据库检索胃癌筛查的经济学评价研究，并采用《2022年卫生经济学评价报告标准》（CHEERS 2022）对纳入文献的报告质量进行评估。仅选取针对胃癌筛查成本效益、成本效用及成本效益分析的原始经济学评价研究。由两名评审员根据预设纳入与排除标准，对选定文献（标题、摘要及全文）进行独立审阅以确定其适用性，若存在分歧则通过作者共识解决。本系统综述关注的主要结局指标包括成本、效益（以质量调整生命年或挽救生命年衡量）以及筛查相较于不筛查或替代筛查方法的增量成本效益比。最终共纳入31项研究，这些研究从一级预防、二级预防或两者结合的角度评估了胃癌筛查的成本效益。主要一级预防干预为幽门螺杆菌筛查及根除治疗，主要二级预防干预为内镜筛查。在观察性研究与模型研究中，成本效益均通过对比不筛查或替代筛查方法进行评估。结果显示，在胃癌高发的亚洲国家及其侨民群体中，筛查普遍具有成本效益；而在西方国家，胃癌筛查通常不具备成本效益。研究表明，胃癌筛查可能具有成本效益，但其效果受特定情境因素影响，包括地理位置、当地人群胃癌患病率及所采用的筛查工具。针对亚洲国家及其侨民中的高风险人群开展胃癌筛查具有积极意义。
A Systematic Review of Cost-Effectiveness Studies on Gastric Cancer Screening
肿瘤(癌症)患者之家