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

doi:10.4251/wjgo.v18.i3.117278

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World Journal of Gastrointestinal Oncology

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Evidence-Based Medicine

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Mar 15, 2026; 18(3): 117278
Published online Mar 15, 2026. doi: 10.4251/wjgo.v18.i3.117278

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

Yu-Si Xu, Ye Gao, Yun-Fei Jiao, Chu-Ting Yu, Wei Wang, Ting-Lu Wang, Chu Chu, Han Lin, Jin-Fang Xu, Lei Xin, Luo-Wei Wang

Yu-Si Xu, Ye Gao, Yun-Fei Jiao, Chu-Ting Yu, Wei Wang, Ting-Lu Wang, Chu Chu, Han Lin, Lei Xin, Luo-Wei Wang, Department of Gastroenterology, Changhai Hospital, Naval Medical University, Shanghai 200433, China

Jin-Fang Xu, Department of Health Statistics, Naval Medical University, Shanghai 200433, China

Co-first authors: Yu-Si Xu and Ye Gao.

Co-corresponding authors: Lei Xin and Luo-Wei Wang.

Author contributions: Xu YS and Gao Y contribute equally to this study as co-first authors; Xin L and Wang LW contribute equally to this study as co-corresponding authors; Xu YS, Gao Y, and Jiao YF were responsible for concept and design; Xu YS, Wang W, and Wang TL were responsible for data acquisition; Xu YS and Yu CT were responsible for data analysis; Xu YS, Chu C, and Lin H were responsible for statistical analysis; Xu YS and Gao Y were responsible for manuscript preparation and editing; Lin H, Xu JF, Xin L, and Wang LW were responsible for manuscript review; all authors have read and agreed to the published version of the manuscript.

Supported by National Natural Science Foundation of China, No. 82370677.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Corresponding author: Luo-Wei Wang, Department of Gastroenterology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai 200433, China. wangluoweimd@126.com

Received: December 4, 2025
Revised: December 30, 2025
Accepted: January 22, 2026
Published online: March 15, 2026
Processing time: 99 Days and 1 Hours

Abstract

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.

Keywords: Cost-effectiveness; Early detection of cancer; Diagnostic test; Esophageal squamous cell carcinoma; Markov model; Sponge cytology test; Endoscopic screening

Core Tip: This study is the first economic evaluation of a minimally invasive sponge cytology screening strategy in areas at high risk for esophageal squamous cell carcinoma (ESCC). We found that both endoscopic and sponge cytology screening programs were highly cost-effective compared with no screening. Among all evaluated strategies, annual sponge cytology screening provided the greatest health benefits at the most favorable cost-effectiveness, indicating that it may represent an optimal population-based screening approach for ESCC in high-risk regions.