OBJECTIVES: Gastric cancer though among the top lethal cancers, has a very low prevalence overall. To ensure early detection, patients presenting with gastric distress in clinics are investigated with endoscopy in Singapore. However, low prevalence even in this group (~0.7%) leads to an immense cost burden. This research analyses the cost-effectiveness of introducing a microRNA-based blood test as a cheap yet effective screen to stratify high-risk patients into gastric cancer risk-levels, enabling a more targeted prescription of endoscopy METHODS: A 5-year decision tree model was developed with a healthcare systems perspective in TreeAgePro2013 to compare the two strategies among high-risk patients in Singapore specialist clinic setting: (a)miRNA test, followed by endoscopy for test-positive patients, (b)universal endoscopy. Modelling patients for four health stages – healthy, early-treatable (stage1), advanced-treatable (Stage2&3), untreatable (stage4); stage-specific treatments, costs, utilities, outcomes and recurrence rates were considered. Missed patients were expected to be diagnosed later with advanced cancers (as per natural disease progression) and face corresponding health and cost implications. Using sensitivity and specificity values, local and published data and conservative assumptions favouring universal endoscopy, the ICER was evaluated on present-value basis at a 3% discount rate. Deterministic and probabilistic sensitivity analysis was done across different variables to verify the model robustness RESULTS: The analysis confirmed the cost-effectiveness of using miRNA-based strategy (ICER: S$198,329/QALY) with a cost-saving of S$200/patient for an average loss of 0.001 QALY (WTP: 1 GDP per capita, S$71,318). Sensitivity analysis further reaffirmed the results with 100% of iterations in PSA favouring miRNA-based strategy up-to a WTP of S$100,000. CONCLUSIONS: The miRNA-based blood test not only offers a moderately to highly cost-effective screen in gastric cancer diagnosis, but with its easy administration and better patient experience in comparison to invasive endoscopy might also promote patient compliance for regular screening and check-ups.