Liquid Biopsy Screening for Gastric Cancer Is Not Cost-Effective at Current Prices
An economic simulation shows that blood-based gastric cancer screening is too expensive for average-risk individuals.
Key takeaways
- A Markov model analysis shows that blood-based liquid biopsy screening for gastric cancer is currently not cost-effective for average-risk individuals in the United States.
- While liquid biopsy tests are effective at reducing gastric cancer incidence and mortality, they yielded an incremental cost-effectiveness ratio of $917,826 per quality-adjusted life-year gained.
- The screening strategy becomes cost-effective if it is restricted to high-risk subpopulations or if the individual test cost is reduced to approximately $89.
- These findings are intended to help guide the design and planning of future clinical validation studies for gastric cancer blood tests.
While blood-based liquid biopsies have emerged as a potential screening approach for gastric cancer, a new economic analysis suggests these tests are currently not cost-effective for routine use in the United States.
Currently, the United States lacks a routine gastric cancer screening program, despite frequent late-stage diagnoses of the disease. To evaluate whether blood-based screening could be cost-effective, researchers developed a Markov model to compare no screening, which is the current standard of care, with two liquid biopsy screening strategies.
The study simulated a cohort of 45-year-old individuals with an average risk of gastric cancer. It found that while liquid biopsy strategies are effective in reducing cancer incidence and mortality, they are not cost-effective under current pricing due to high test costs.
What Happened
Researchers developed a Markov model to compare no screening against two liquid biopsy screening strategies in a simulated cohort of 45-year-old individuals with an average risk of gastric cancer. The primary outcomes measured in the model were life expectancy, quality-adjusted life-years (QALYs), total cost, and incremental cost-effectiveness ratios (ICERs). Under U.S. guidelines, a strategy was considered cost-effective if the ICER was below the willingness-to-pay threshold of $100,000 per QALY gained. In the base-case analysis, the liquid biopsy screening strategies were not cost-effective, yielding an ICER of $917,826 per QALY gained.
What The Evidence Shows
The economic evaluation, published in JNCI Cancer Spectrum in September 2026, demonstrated that liquid biopsy screening strategies successfully reduce gastric cancer incidence and mortality. However, due to high test costs, these strategies are not cost-effective for average-risk individuals. The analysis showed that screening became cost-effective only when applied to high-risk subpopulations or when the per-test cost was reduced to approximately $89.
What We Don't Know Yet
The published source does not report specific study limitations or detailed model parameters beyond the base-case results and thresholds described. It does not provide real-world clinical validation data, as it is based on a simulated Markov model of 45-year-old average-risk individuals.
What Comes Next
The study findings could help inform the potential planning of future clinical validation studies for liquid biopsy tests used for gastric cancer screening. The published source does not report any other specific plans or next steps for the researchers or trial sponsors.
What This Means
Based on the study findings, universal liquid biopsy screening for gastric cancer is not economically viable for average-risk individuals in the United States at current commercial prices. However, blood-based screening represents a potentially viable economic strategy when focused specifically on high-risk subpopulations or if the cost of the test can be significantly reduced.
Original Source
PubMed (NCBI E-utilities): https://pubmed.ncbi.nlm.nih.gov/42708613/
Questions readers ask
- Is liquid biopsy screening for gastric cancer currently recommended in the United States?
- No, the United States currently lacks a routine screening program for gastric cancer. While liquid biopsy has emerged as a potential blood-based screening method, economic analyses show it is not cost-effective for the general public at current prices.
- Why is liquid biopsy screening for gastric cancer not considered cost-effective?
- In a simulated cohort of average-risk 45-year-olds, the screening strategy resulted in an incremental cost-effectiveness ratio of $917,826 per quality-adjusted life-year (QALY) gained. This far exceeds the standard U.S. willingness-to-pay threshold of $100,000 per QALY.
- Under what conditions could gastric cancer blood tests become cost-effective?
- According to the model, liquid biopsy screening becomes cost-effective if it is targeted specifically at high-risk subpopulations rather than average-risk individuals, or if the cost per test drops to approximately $89.
What this means
Based on the study findings, universal liquid biopsy screening for gastric cancer is not economically viable for average-risk individuals in the United States at current commercial prices. However, blood-based screening represents a potentially viable economic strategy when focused specifically on high-risk subpopulations or if the cost of the test can be significantly reduced.
Limitations and uncertainties
- The published source does not report specific study limitations or detailed model parameters beyond the base-case results and thresholds described. It does not provide real-world clinical validation data, as it is based on a simulated Markov model of 45-year-old average-risk individuals.
Sources
- Cost-Effectiveness of liquid biopsy screening for gastric cancer in the United States. — PubMed (NCBI E-utilities)
