OBJECTIVES: Currently there is no population screening program for gastric cancer in Singapore. This can be attributed to a low disease incidence and expensive screening tests. However, the disease prevalence varies significantly across segments with 4-40 times higher incidence in intermediate and high-risk population groups. This study aims to evaluate the cost-effectiveness of implementing a screening program using a novel miRNA-based blood test (developed by scientists in Singapore) in the two above mentioned population segments.

METHODS: Independent markov models were developed for the two segments: 1) intermediate-risk (male residents with Chinese ethnicity, aged 50-75 years); 2) high-risk (specialist clinic patients with prolonged gastric distress). The intervention of screening using miRNA-blood test, followed by a confirmatory endoscopy for test positive patients was compared with the current practised strategies- no population screening for intermediate-risk; endoscopic screening for high-risk patients. The intermediate risk segment was studied in a 25-year population screening setup with 3 yearly follow-ups for test negative patients whereas the high-risk analysis was based on one-time evaluation. Stage specific estimates for test sensitivity, treatment efficacy, disease progression, cancer recurrence and mortality were considered. Outcomes representing ICER, number needed to screen(NNS), program cost, early diagnosis, and threshold values for costs, test accuracy and compliance were evaluated.

RESULTS: In intermediate-risk group, the miRNA-based screening methodology was found to be cost-effective with an ICER of USD 28,931/ QALY, up to 80% increase in early diagnosis, a NNS of 509 and total program cost of 103 million USD in 25 years. In high-risk patients, the proposed strategy was found to be cost-savings with health gains. Program cost were estimated to reduce by 55%, saving 45 Mn USD in one year with a 16% improved cancer diagnosis rate in the target segment.

CONCLUSIONS: The novel miRNA test was found to be highly cost-effective in both the population segments.