OBJECTIVES: To compare the cost-effectiveness of pronase granules combined with simethicone versus simethicone alone for gastric cancer screening in high-risk populations in China.

METHODS: From the perspective of the Chinese healthcare system, a 13-state Markov model was constructed to simulate the long-term costs and health benefits—quality-adjusted life years (QALYs)—of different endoscopic screening strategies (varied screening initiation years and intervals) using pronase granules combined with simethicone versus simethicone alone. The model had a yearly cycle and a lifelong time horizon, calculating the incremental cost-effectiveness ratio (ICER). Model parameters were derived from clinical trials of pronase granules, literature, third-party databases, and clinical expert opinions. Additionally, one-way and probabilistic sensitivity analyses were conducted to explore the uncertainty around the base-case analysis results.

RESULTS: The base-case analysis demonstrated that, after excluding absolute and extended dominated strategies, if 2-3 times the per capita GDP was used as a threshold, screening annually with pronase granules was the most cost-effective strategy in the comparison of all scenarios and across different age subgroups. The sensitivity analysis results were robust.

CONCLUSIONS: Under equivalent conditions, earlier screening ages, shorter screening intervals, and utilizing pronase granules combined with simethicone for gastric cancer screening instead of using simethicone alone are more cost-effective.