title: Cost-effectiveness outcomes of the national gastric cancer screening program in South Korea.
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.
  
  
  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.
  
  
  CONCLUSIONS
  Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.
authors.affiliation: College of Pharmacy, Sookmyung Women's University, Seoul, Korea.
authors.forename: Eun
authors.initials: E
authors.lastname: Cho
authors.forename: Moon Hae
authors.initials: MH
authors.lastname: Kang
authors.forename: Kui Son
authors.initials: KS
authors.lastname: Choi
authors.forename: Mina
authors.initials: M
authors.lastname: Suh
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Jun
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality; D015996:Survival Rate