MODELING THE COST-EFFECTIVENESS OF RISK-STRATIFIED SCREENING FOR ESOPHAGEAL CANCER IN CHINA
Author(s)
Xuechen Xiong, PhD1, Zhaohua Huo, PhD2, Carmen S Ng, PhD3, Sai Yin Daniel Ho, PhD3, June Yue Yan Leung, PhD4, Shiu Lun Au Yeung, PhD3, Jianchao Quan, PhD3;
1The Hong Kong Polytechnic University, Hung Hom, Hong Kong, 2The Chinese University of Hong Kong, Hong Kong, China, 3The University of Hong Kong, Hong Kong, China, 4Massey University, New Zealand, New Zealand
1The Hong Kong Polytechnic University, Hung Hom, Hong Kong, 2The Chinese University of Hong Kong, Hong Kong, China, 3The University of Hong Kong, Hong Kong, China, 4Massey University, New Zealand, New Zealand
OBJECTIVES: To evaluate the cost-effectiveness of population-based, risk-tailored ESCC screening strategies in China, with the goal of informing national policy and providing insights for similar high-burden settings across Asia.
METHODS: We conducted a model-based cost-effectiveness analysis of ESCC screening strategies in Chinese adults aged 30-79 years. A cohort Markov model simulated disease progression across health states over a lifetime horizon from a healthcare perspective. The model evaluated uniform age-based screening versus risk-stratified strategies incorporating age, sex, geographic area, ALDH2 genotype, and alcohol consumption. Inputs were drawn from published sources, with uncertainty addressed through probabilistic sensitivity analysis. Outcomes included incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for population segments.
RESULTS: Uniform screening every five years for all adults aged 30-79 yielded an ICER of $92,595 (95% CI: $82,565-$104,705), exceeding the willingness-to-pay threshold of $39,000, indicating it is not cost-effective. Stratified analysis revealed substantial heterogeneity. Screening was more cost-effective in males (ICER $71,600) than females ($137,200) and in 60-69 age groups (ICER $ 80,900), but neither age- nor gender-based strategies alone achieve cost-effectiveness. Alcohol intake and genetic factors were strong modifiers. Heavy drinkers with ALDH2 deficiency had ICERs well below the WTP threshold, particularly at younger ages: $20,400, $23,300, and $31,500 for ages 30-39, 40-49, and 50-59, respectively. Moderate drinkers with ALDH2 deficiency aged 30-49 also met cost-effectiveness criteria, with ICERs ranging from $27,900 to $32,800.
CONCLUSIONS: Risk-tailored strategies that incorporate ALDH2 genotype and alcohol consumption substantially improve efficiency compared to uniform approaches. These strategies expand the cost-effective age range to 30-59 years for high-risk profiles, beyond the current guideline threshold of 40 years. It supports transitioning from rigid age-based eligibility to precision screening approaches that integrate genetic and behavioral risk factors, informing policy development in China and other high-burden Asian settings.
METHODS: We conducted a model-based cost-effectiveness analysis of ESCC screening strategies in Chinese adults aged 30-79 years. A cohort Markov model simulated disease progression across health states over a lifetime horizon from a healthcare perspective. The model evaluated uniform age-based screening versus risk-stratified strategies incorporating age, sex, geographic area, ALDH2 genotype, and alcohol consumption. Inputs were drawn from published sources, with uncertainty addressed through probabilistic sensitivity analysis. Outcomes included incremental costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) for population segments.
RESULTS: Uniform screening every five years for all adults aged 30-79 yielded an ICER of $92,595 (95% CI: $82,565-$104,705), exceeding the willingness-to-pay threshold of $39,000, indicating it is not cost-effective. Stratified analysis revealed substantial heterogeneity. Screening was more cost-effective in males (ICER $71,600) than females ($137,200) and in 60-69 age groups (ICER $ 80,900), but neither age- nor gender-based strategies alone achieve cost-effectiveness. Alcohol intake and genetic factors were strong modifiers. Heavy drinkers with ALDH2 deficiency had ICERs well below the WTP threshold, particularly at younger ages: $20,400, $23,300, and $31,500 for ages 30-39, 40-49, and 50-59, respectively. Moderate drinkers with ALDH2 deficiency aged 30-49 also met cost-effectiveness criteria, with ICERs ranging from $27,900 to $32,800.
CONCLUSIONS: Risk-tailored strategies that incorporate ALDH2 genotype and alcohol consumption substantially improve efficiency compared to uniform approaches. These strategies expand the cost-effective age range to 30-59 years for high-risk profiles, beyond the current guideline threshold of 40 years. It supports transitioning from rigid age-based eligibility to precision screening approaches that integrate genetic and behavioral risk factors, informing policy development in China and other high-burden Asian settings.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE62
Topic
Economic Evaluation
Disease
SDC: Oncology