Economic evaluation of sponge cytology test vs. endoscopy for esophageal squamous cell carcinoma screening in high-risk areas: a cost-effectiveness study

Background: Recent advances in esophageal sponge cytology tests highlight their potential in esophageal squamous cell carcinoma (ESCC) screening, but their cost-effectiveness remains less clear. This study aims to investigate the cost-effectiveness of the sponge cytology test for ESCC screening in high-risk areas. Materials and Methods: We built a Markov model simulating 100,000 participants aged 45 years old in ESCC high-risk areas to project the cost-effectiveness of several screening strategies: no screening, endoscopic screening, and sponge cytology screening (with subsequent endoscopy for positive ones) with different intervals (one-time, per 10 years, per 5 years, per 3 years, per 2 years, and per year). Outcomes included ESCC cases and deaths, cost, quality-adjusted life year (QALY), and incremental cost-effective ratio (ICER). A healthcare sector perspective was adopted in our analysis. Findings: All screening strategies had ESCC cases reduced and deaths prevented compared with no screening (373-2,962 vs. 3,134 and 257-2,305 vs. 2,409 per 100,000 participants, respectively). Shorter screening intervals are associated with higher QALYs gained per person (one-time to per year: 532-5,972 for endoscopy and 747-7,162 for sponge cytology test). An annual sponge cytology test strategy was considered the most cost-effective with the greatest QALYs gained and an ICER of $6,630 per QALY among all strategies. Endoscopy screening strategies were dominated by annual sponge cytology strategy. Interpretation: Our findings suggest that the sponge cytology screening strategy is cost-effective in ESCC high-risk areas and is worth being considered by policymakers for implementation.