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However,\u00a0relatively high costs impair the widespread use of LPL in some resource\u2010limited regions in China, and the cost\u2010effectiveness of PCY testing remains unclear. Therefore, we performed a decision analysis to evaluate the cost\u2010effectiveness of PCY testing by comparing the guideline\u2010recommended intraoperative LPL, a newly proposed preoperative percutaneous peritoneal lavage (PPL), and a third strategy of exploratory laparotomy with no cytology testing (ELNC) among GC patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed a decision\u2010analytic Markov model of the aforementioned three strategies for a hypothetical cohort of GC patients with curative intent after initial imaging, from the perspective of Chinese society. We estimated costs, quality\u2010adjusted life years (QALYs), and incremental cost\u2010effectiveness ratios (ICERs) as primary outcomes; we also conducted\u00a0one\u2010way and probabilistic sensitivity analyses to investigate the model's robustness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that ELNC was dominated (i.e., more expensive and less effective) by PPL and LPL. LPL was the most cost\u2010effective method with an ICER of US$17,200\/QALY compared to PPL, which was below the Chinese willingness\u2010to\u2010pay (WTP) threshold of US$29,313 per QALY gained. In sensitivity analyses, PPL was more likely to be cost\u2010effective with a lower WTP threshold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Cytology testing through either LPL or PPL was less expensive and more effective than ELNC among GC patients. Moreover, LPL was the most cost\u2010effective modality at the current WTP threshold, while PPL could potentially be cost\u2010effective in lower\u2010income areas.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.3518","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T11:21:31Z","timestamp":1602588091000},"page":"8940-8949","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A decision analysis comparing three strategies for peritoneal lavage cytology testing in staging of gastric cancer in China"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0059-9493","authenticated-orcid":false,"given":"Qifei","family":"He","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education) Peking University Cancer Hospital &amp; Institute Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinyi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Center for Health Decision Science Harvard T.H. 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