Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

  • Cho, Eun (College of Pharmacy, Sookmyung Women's University) ;
  • Kang, Moon Hae (Graduate School of Yonsei University) ;
  • Choi, Kui Son (National Cancer Control Research Institute, National Cancer Center) ;
  • Suh, MiNa (National Cancer Control Research Institute, National Cancer Center) ;
  • Jun, Jae Kwan (National Cancer Control Research Institute, National Cancer Center) ;
  • Park, Eun-Cheol (Institute of Health Services Research, Yonsei University)
  • Published : 2013.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Although screening is necessary where gastric cancer is particularly common in Asia, the performance outcomes of mass screening programs have remained unclear. This study was conducted to evaluate cost-effectiveness outcomes of the national cancer screening program (NCSP) for gastric cancer in South Korea. Materials and Methods: People aged 40 years or over during 2002-2003 (baseline) were the target population. Screening recipients and patients diagnosed with gastric cancers were identified using the NCSP and Korea Central Cancer Registry databases. Clinical outcomes were measured in terms of mortality and life-years saved (LYS) of gastric cancer patients during 7 years based on merged data from the Korean National Health Insurance Corporation and National Statistical Office. We considered direct, indirect, and productivity-loss costs associated with screening attendance. Incremental cost-effectiveness ratio (ICER) estimates were produced according to screening method, sex, and age group compared to non-screening. Results: The age-adjusted ICER for survival was 260,201,000-371,011,000 Korean Won (KW; 1USD=1,088 KW) for the upper-gastrointestinal (UGI) tract over non-screening. Endoscopy ICERs were lower (119,099,000-178,700,000 KW/survival) than UGI. To increase 1 life-year, additional costs of approximately 14,466,000-15,014,000 KW and 8,817,000-9,755,000 KW were required for UGI and endoscopy, respectively. Endoscopy was the most cost-effective strategy for males and females. With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. For males, an upper limit of age 75 or 80 years could be considered. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective. Conclusion: Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.

Keywords

References

  1. Andersen MR, Urban N, Ramsey S, Briss PA (2004). Examining the cost-effectiveness of cancer screening promotion. Cancer, 101, 1229-38. https://doi.org/10.1002/cncr.20511
  2. Babazono A, Hillman AL (1995). Declining cost-effectiveness of screening for disease. The case of gastric cancer in Japan. Int J Technology Assessment in Health Care, 11, 354-64. https://doi.org/10.1017/S0266462300006954
  3. Cha JM, Han DS, Lee HL, et al (2012). Endoscopist specialty is associated with high-quality endoscopy in Korea. Yonsei Med J, 53, 310-7. https://doi.org/10.3349/ymj.2012.53.2.310
  4. Chang H, Park E, Chung W, et al (2012). Comparing endoscopy and upper gastrointestinal X-ray for gastric cancer screening in South Korea: a cost-utility analysis. Asian Pac J Cancer Prev, 13, 2721-8. https://doi.org/10.7314/APJCP.2012.13.6.2721
  5. Choi KS, Jun JK, Lee HY, et al (2011). Performance of gastric cancer screening by endoscopy testing through the National Cancer Screening Program of Korea. Cancer Sci, 102, 1559-64. https://doi.org/10.1111/j.1349-7006.2011.01982.x
  6. Choi KS, Kwak M, Lee H, et al (2009). Screening for gastric cancer in Korea: population-based preferences for endoscopy versus upper gastrointestinal series. Cancer Epidemiology, Biomarkers & Prev, 18, 1390-8. https://doi.org/10.1158/1055-9965.EPI-08-0940
  7. Chung SJ, Park MJ, Kang SJ, et al (2012). Effect of annual endoscopic screening on clinicopathologic characteristics and treatment modality of gastric cancer in a high-incidence region of Korea. Int J Cancer, 131, 2376-84. https://doi.org/10.1002/ijc.27501
  8. Committee of National Statistics (2007). The 2004 annual report of mass screening for digestive organs. J Gastroenterol Cancer Screen, 45, 49-68.
  9. Correa P (2004). Is gastric cancer preventable? Gut, 53, 1217-9. https://doi.org/10.1136/gut.2004.039834
  10. Dan YY, So JB, Yeoh KG (2006). Endoscopic screening for gastric cancer. Clinical gastroenterology and hepatology, 4, 709-16. https://doi.org/10.1016/j.cgh.2006.03.025
  11. Gupta N, Bansal A, Wani SB, et al (2011). Endoscopy for upper GI cancer screening in the general population: a cost-utility analysis. Gastrointest Endosc, 74, 610-24. https://doi.org/10.1016/j.gie.2011.05.001
  12. Hahm MI, Choi KS, Lee HY, et al (2011). Who participates in the gastric cancer screening and on-time rescreening in the National Cancer Screening Program? A population-based study in Korea. Cancer Sci, 102, 2241-7. https://doi.org/10.1111/j.1349-7006.2011.02090.x
  13. Ito Y, Ioka A, Tsukuma H, et al (2009). Regional differences in population-based cancer survival between six prefectures in Japan: application of relative survival models with funnel plots. Cancer Science, 100, 1306-11. https://doi.org/10.1111/j.1349-7006.2009.01170.x
  14. Kim Y, Jun JK, Choi KS, et al (2011). Overview of the National Cancer screening programme and the cancer screening status in Korea. Asian Pac J Cancer Prev, 12, 725-30.
  15. Kim YS, Park HA, Kim BS, et al (2000). Efficacy of screening for gastric cancer in a Korean adult population: a case-control study. J Korean Med Sci, 15, 510-5. https://doi.org/10.3346/jkms.2000.15.5.510
  16. Korean Statistical Information Service (KOSIS) (2012). http://kosis.kr/index/index.jsp.
  17. Lee H, Park E, Jun J, et al (2010). Comparing upper gastrointestinal X-ray and endoscopy for gastric cancer diagnosis in Korea. World J Gastroenterology, 16, 245-50. https://doi.org/10.3748/wjg.v16.i2.245
  18. Lee HY, Lim SM, Han MA, et al (2011). Assessment of participant satisfaction with upper gastrointestinal endoscopy in South Korea. World J Gastroenterol, 17, 4124-9. https://doi.org/10.3748/wjg.v17.i36.4124
  19. Lee KS, Oh DK, Han MA, et al (2011). Gastric cancer screening in Korea: report on the national cancer screening program in 2008. Cancer Research and Treatment, 43, 83-8. https://doi.org/10.4143/crt.2011.43.2.83
  20. Leung WK, Wu MS, Kakugawa Y, et al (2008). Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol, 9, 279-87. https://doi.org/10.1016/S1470-2045(08)70072-X
  21. Mansour-Ghanaei F, Sokhanvar H, Joukar F, et al (2012). Endoscopic findings in a mass screening program for gastric cancer in a high risk region-Guilan province of Iran. Asian Pac J Cancer Prev, 13, 1407-12. https://doi.org/10.7314/APJCP.2012.13.4.1407
  22. Ministry of Health and Welfare (2002-2011). Korea National Cancer Screening Program guidebook. Division of Cancer Policy.
  23. Miyamoto A, Kuriyama S, Nishino Y, et al (2007). Lower risk of death from gastric cancer among participants of gastric cancer screening in Japan: a population-based cohort study. Prev Med, 44, 12-9. https://doi.org/10.1016/j.ypmed.2006.07.016
  24. Nam SY, Choi IJ, Park KW, et al (2009). Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol, 21, 855-60. https://doi.org/10.1097/MEG.0b013e328318ed42
  25. Nishi M, Ishihara S, Nakajima T, et al (1995). Chronological changes of characteristics of early gastric cancer and therapy: experience in the Cancer Institute Hospital of Tokyo, 1950-1994. J Cancer Res And Clin Oncol, 121, 535-41. https://doi.org/10.1007/BF01197766
  26. Ohata H, Oka M, Yanaoka K, et al (2005). Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography. Cancer Sci, 96, 713-20. https://doi.org/10.1111/j.1349-7006.2005.00098.x
  27. Park B, Lee H, Choi KS, et al (2011). Cancer screening in Korea, 2010: results from the Korean National Cancer Screening Survey. Asian Pac J Cancer Prev, 12, 2123-8.
  28. Park EC, Choi KS, Kim SG, Lim JH (2003). A study on the estimation of cost related to cancer care and burden of cancer diseases. National Cancer Center (Korean), Goyang.
  29. Park YM, Cho E, Kang HY, Kim JM (2011). The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc, 25, 2666-77. https://doi.org/10.1007/s00464-011-1627-z
  30. Statistics Korea 2009-2011. Ministry of Employment and Labor, Employment Policy Office. .
  31. Statistics Korea (2012). Consumer Price Index in November 2012. Price Statistics Division, Economic Statistics Bureau.
  32. The Third Korea National Health and Nutrition Examination Survey (KNHANES III). (2005).
  33. Tsubono Y, Hisamichi S (2000). Screening for gastric cancer in Japan. Gastric Cancer, 3, 9-18. https://doi.org/10.1007/PL00011692
  34. Whiting JL, Sigurdsson A, Rowlands DC, et al (2002). The long term results of endoscopic surveillance of premalignant gastric lesions. Gut, 50, 378-81. https://doi.org/10.1136/gut.50.3.378

Cited by

  1. Cost-Effectiveness of Korea's National Cervical Cancer Screening Program vol.14, pp.7, 2013, https://doi.org/10.7314/APJCP.2013.14.7.4329
  2. eradication on prevention of gastric cancer vol.28, pp.5, 2013, https://doi.org/10.3904/kjim.2013.28.5.525
  3. Health Economics Evaluation of a Gastric Cancer Early Detection and Treatment Program in China vol.15, pp.13, 2014, https://doi.org/10.7314/APJCP.2014.15.13.5133
  4. Risk of Lymph Node Metastases from Early Gastric Cancer in Relation to Depth of Invasion: Experience in a Single Institution vol.15, pp.13, 2014, https://doi.org/10.7314/APJCP.2014.15.13.5371
  5. Massive Endoscopic Screening for Esophageal and Gastric Cancers in a High-Risk Area of China vol.10, pp.12, 2015, https://doi.org/10.1371/journal.pone.0145097
  6. Gastric Cancer in Asian American Populations: a Neglected Health Disparity vol.15, pp.24, 2015, https://doi.org/10.7314/APJCP.2014.15.24.10565
  7. The Korean guideline for gastric cancer screening vol.58, pp.5, 2015, https://doi.org/10.5124/jkma.2015.58.5.373
  8. Trends in gastric cancer mortality and in the prevalence of Helicobacter pylori infection in Portugal vol.25, pp.4, 2016, https://doi.org/10.1097/CEJ.0000000000000183
  9. Does the interval of screening endoscopy affect survival in gastric cancer patients? vol.95, pp.49, 2016, https://doi.org/10.1097/MD.0000000000005490
  10. Gastric Cancer Screening Uptake Trends in Korea vol.94, pp.8, 2015, https://doi.org/10.1097/MD.0000000000000533
  11. antibody and positive serum pepsinogen test in healthy Koreans vol.19, pp.9, 2018, https://doi.org/10.1111/1751-2980.12660