Cost-effectiveness of sponge cytology test vs endoscopy for esophageal squamous cell carcinoma screening in high-risk areas

BACKGROUND Recent advances in esophageal sponge cytology tests highlight their potential in esophageal squamous cell carcinoma (ESCC) screening, but their cost-effectiveness remains unclear. AIM To investigate the cost-effectiveness of the sponge cytology test for ESCC screening in high-risk areas. METHODS We built a Markov model simulating 100000 participants aged 45 years 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 results) with different intervals. Outcomes included ESCC cases and deaths, cost, quality-adjusted life year (QALY), and incremental cost-effective ratio (ICER). RESULTS All screening strategies reduced ESCC cases and prevented deaths compared with no screening (373-2962 vs 3134 and 257-2305 vs 2409 per 100000 participants, respectively). Shorter screening intervals were associated with higher QALYs gained per person (one-time to per year: 532-5972 for endoscopy and 747-7162 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 6630 USD per QALY among all strategies. Endoscopy screening strategies were dominated by the annual sponge cytology strategy. CONCLUSION Our findings suggest that the sponge cytology screening strategy is cost-effective in ESCC high-risk areas and may inform policy decision-making.