Simulation Models in Gastric Cancer Screening: A Systematic Review

Document Type : Systematic Review and Meta-analysis


1 Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.

2 Division of Screening Assessment and Management, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.

3 Department of Medical Informatics, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.

4 Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.

5 Department of Plastic and Reconstructive Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan.


Background: Together with such high-quality approaches as randomized controlled trials and large-scale cohort
studies, simulation models are often employed to evaluate the effect of cancer screening methods and decide on
their appropriateness. This study aimed to evaluate all effects of gastric cancer screening that have been assessed
using simulation models, including cost-effectiveness, mortality reduction, and early-stage detection. Methods: We
performed a systematic review using PubMed and Web of Science. We evaluated the effect of screening related to
cost, such as incremental cost-effectiveness and incremental cost-effectiveness ratios; we also separately assessed
effects other than cost, such as quality-adjusted life-years, number of deaths prevented, life-years saved, relative risk
of mortality from gastric cancer, life expectancy, and incidence reduction. The methods targeted for evaluation were
Helicobacter pylori testing or endoscopy. Results: We identified 19 studies dealing with simulation models in gastric
cancer screenings: 14 examined H. pylori screening and 7 focused on endoscopy. Among those studies, two assessed
both H. pylori and endoscopy screening. Most of the studies adopted a Markov model, and all the studies evaluated
cost-effectiveness. Of the 14 H. pylori screening studies, 13 demonstrated cost-effectiveness and 11 also showed good
results other than cost-effectiveness, such as extension of life-years and increase in early-stage detection. In three of the
five endoscopy studies, the target population was patients; all five studies obtained good results for cost-effectiveness
and four observed good results other than for cost-effectiveness. Conclusions: In this study, we showed that the H.
pylori screening test was cost-effective in terms of simulation model investigations. However, the H. pylori screening
test should not ordinarily be recommended since there is insufficient evidence that it reduces gastric cancer mortality.
In Japan, simulation modeling should be employed to plan for cancer control, and the appropriate use of simulation
models should be examined for future use.


Main Subjects