Objective: Associated with no screening, H. pylori serology screening, and the 13C-Urea breath test (UBT) for gastric cancer in Chinese. Methods: A Markov model simulation was carried out in Singaporean Chinese at age of 40 years (n=478,500) from the perspective of public health care providers. The main outcome measures were costs, number of gastric cancer cases prevented, life years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation. Results: The ICER of serology screening versus no screening was $25,881 per QALY gained (95% confidence interval (95% CI): $5700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95% CI: $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY. Conclusion: It cannot be confidently concluded that either H. pylori screening was a cost-effective strategy compared to no screening in all Chinese at age of 40 years. Nevertheless, serology screening has demonstrated much more potentiality to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.