OBJECTIVES: Gastric cancer (GC) is the fourth common cancer world-wide.Prevalence of GC increased during the last decades , due to dietary habit and socio-economic level, it still accounts for 10% of the total cancer-related deaths. The best strategy to reduce the mortality of GC and related high cost is to provide appropriate screening programs. The aim of study is to evaluate cost effectiveness methods of GC screening in Iranian high risk groups.

METHODS: A model-based economic evaluation through decision tree was performed. Related data including sensitivity of different screening methods taken from systematic review of relevant databases: PubMed, Cochran,Scopus, and Google scholar, was conducted in December 2017. This study considered strategies of endoscopy, pepsinogen test, radiography, and no screening in GC. Costs were calculated to the Iran healthcare system through payer perspective and measured effectiveness using quality-adjusted life years (QALYs) and life years gained (LY).

RESULTS : The 2866 studies were found in the first phase of searching through databases. After eliminating duplicate studies and studies incompatible with the inclusion and exclusion criteria of our study, 8 study selected. The sensitivity of endoscopy, radiography and pepsinogen testing were 93%, 83% and 77% respectively. The results of modeling showed that total costs of treatment for no screening strategy in 5-year period was $717,528,050,whereas the total costs of Endoscopy ,Radiography and pepsinogen testing were $234,625,192, $214,776,499,and $222,651,491,respectively. Incremental cost effectiveness ratio (ICER) of screening with endoscopy, radiography and pepsinogen test compared to no screening were -$6,098, -$7,993 and -$6,635 per QALY, respectively.

CONCLUSIONS:

According to the findings of this study, endoscopy, pepsinogen test, and radiography are all effective and dominant options. Endoscopy was the best option for screening the Iranian population at risk, and then the pepsinogen test is introduced for determining the population at risk

Keywords: Cost effectiveness, gastric cancer, screening, Endoscopy, Radiography, pepsinogen test