Background: Endoscopic screening for gastric cancer is debatable in countries with an intermediate risk.
Objective: The objective of this article is to determine the cost-utility of screening strategies for gastric cancer in a European country.
Methods: We conducted a cost-utility analysis using a Markov model comparing three screening strategies versus no screening: stand-alone upper endoscopy, endoscopy combined with a colorectal cancer screening colonoscopy after a positive faecal occult blood test or pepsinogens serologic screening. Clinical data were collected from systematic reviews, costs from published national data and utilities as quality-adjusted life years (QALY). The primary outcome was the incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were performed. The threshold was set at €37,000 (2016 prices).
Results: Upper endoscopy combined with screening colonoscopy (every 10 or 5 years) had an ICER of 15,407/QALY and €30,908/QALY respectively, stand-alone endoscopic screening (every five years) an ICER of €70,693/QALY and pepsinogens screening an ICER of €143,344/QALY. Sensitivity analyses revealed that only endoscopic costs <€75, a provision of only three endoscopies per patient or a gastric cancer risk >25/100,000 would make stand-alone endoscopic screening cost-effective.
Conclusion: Endoscopic gastric cancer screening in Europe can be cost-effective if combined with a screening colonoscopy in countries with a gastric cancer risk ≥10 per 100,000.

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Keywords costs and cost analysis, early detection of cancer, gastrointestinal endoscopy, Markov chains, Stomach neoplasm
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Journal United European Gastroenterology Journal
Areia, M, Spaander, M.C.W, Kuipers, E.J, & Dinis-Ribeiro, M. (2018). Endoscopic screening for gastric cancer. United European Gastroenterology Journal (Vol. 6, pp. 192–202). doi:10.1177/2050640617722902