SRS201 - Gastric cancer screening: cost-effectiveness of endoscopy and point-of-care testing in Ireland

Abstract Background In low-incidence settings, the value of gastric-cancer screening is uncertain. We developed an Irish economic model that explicitly separated intestinal- and diffuse-type disease across epidemiology, natural history, stage, treatment, and mortality. Methods A cohort Markov model followed two groups (A ≥ 45 y; B ≥ 65 y). Strategies were: no screening; oesophagogastroduodenoscopy (OGD) every 5 years; modified ABC serology every 3 years (Groups C/D→OGD); and ABC⁺ every 3 years (ABC with urea breath test and eradication). Outcomes were costs (2024 €), QALYs, ICERs, and NMB from HSE and societal perspectives (4%/1.5% discounting). Histology-specific stage distributions used Irish registry data; natural history was calibrated to national incidence. Uncertainty was explored with one-way and focused probabilistic sensitivity analyses. Results No strategy was cost-effective at €45 000/QALY. In Cohort A/HSE, ABC⁺ produced the greatest gain (+0.0079 QALYs at +€1085; ICER €137k/QALY), dominating OGD and extendedly dominating modified ABC. In Cohort B/HSE, ABC⁺ remained best among screeners (ICER €222k/QALY). Societal results were less favourable. One-way analysis identified ABC⁺ programme cost as the largest driver of NMB, followed by progression rate, eradication effectiveness, and stage shift. In focused PSA, ABC⁺ and modified ABC shared the frontier in Cohort A, while modified ABC was more often feasible in Cohort B; OGD was rarely competitive. Conclusions In Ireland’s low-incidence context, population screening is not currently cost-effective. ABC⁺ is most promising; lowering programme cost, improving stage shift and eradication, and targeting higher-risk groups, supported by better Irish data, may make point-of-care screening viable.