Cost-effectiveness of liquid biopsy screening for gastric cancer in the United States

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Abstract
Background: Despite the frequent late-stage diagnosis of gastric cancer (GC), the United States lacks a routine GC screening program. Liquid biopsy (LB), specifically blood-based tests, has emerged as a potential screening approach, but it is unclear whether such a strategy is cost-effective. We, therefore, evaluated the cost-effectiveness of LB screening for GC in the United States. Methods: A Markov model was developed to compare no screening (current standard-of-care) and 2 LB-screening strategies. The study used a simulated cohort of 45-year-old individuals with average risk of GC. Primary model outcomes included life expectancy, quality-adjusted life-years (QALYs), total cost, and incremental cost-effectiveness ratios (ICERs). A strategy was considered cost-effective if the ICER was < the US willingness-to-pay threshold of $100 000 per quality-adjusted-life-year gained. Results: In the base-case analysis, LB screening strategies were not cost-effective, with an ICER of $917 826 per QALY gained. Screening became cost-effective for high-risk subpopulations or when the per-test cost was approximately $89. Conclusions: This economic evaluation of LB for GC screening found that while LB strategies are effective in reducing cancer incidence and mortality, they are not cost-effective due to high test costs. Our findings could help inform the potential planning of future clinical validation studies for LB tests used for GC screening.
Funding Information
  • National Cancer Institute (U01CA265729)
  • National Cancer Institute (U24CA272897)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32DK083256)

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