scholarly journals The cost-effectiveness of screening for Helicobacter pylori to reduce mortality and morbidity from gastric cancer and peptic ulcer disease: a discrete-event simulation model

2003 ◽  
Vol 7 (6) ◽  
Author(s):  
P. Roderick ◽  
R. Davies ◽  
J. Raftery ◽  
D. Crabbe ◽  
R. Pearce ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Cost Effectiveness ◽  
Discrete Event ◽  
Mortality And Morbidity ◽  
Ulcer Disease ◽  
Event Simulation ◽  
Discrete Event Simulation Model ◽  
The Cost

Cost-Effectiveness of Population Screening for Helicobacter Pylori in Preventing Gastric Cancer and Peptic Ulcer Disease, Using Simulation

2003 ◽  
Vol 10 (3) ◽  
pp. 148-156 ◽  
Author(s):  
P Roderick ◽  
R Davies ◽  
J Raftery ◽  
D Crabbe ◽  
R Pearce ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Population Screening ◽  
Sensitivity Analyses ◽  
Ulcer Disease ◽  
H Pylori ◽  
The Cost

Objectives: To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales. Methods: A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYSj for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken. Results: The cost/LYS from screening at age 40 years was £5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded £20000 over an 80-year follow-up, but did for shorter periods. Conclusions: H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.

Cost-Effectiveness of Screening With Polymerase Chain Reaction For Helicobacter Pylori To Prevent Gastric Cancer And Peptic Ulcers

2021 ◽  
Author(s):  
Aaron Oh ◽  
Han Truong ◽  
Judith Kim ◽  
Sheila D. Rustgi ◽  
Julian A. Abrams ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Peptic Ulcer ◽  
Cost Effectiveness ◽  
Peptic Ulcer Disease ◽  
Cost Effective ◽  
Population Screening ◽  
Pcr Screening ◽  
Ulcer Disease ◽  
Polymerase Chain ◽  
H Pylori

Abstract Background: Helicobacter pylori is a major risk factor for gastric cancer. Screening and treatment of H. pylori may reduce the risk of gastric cancer and peptic ulcer disease. Polymerase chain reaction (PCR) of gastric biopsies provides superior sensitivity and specificity for the detection of H. pylori. This study explores whether population-based H. pylori screening with PCR is cost-effective in the US.Methods: A Markov cohort state-transition model was developed to compare three strategies: no screening with opportunistic eradication, 13C-UBT population screening and treating of H. pylori, and PCR population screening and treating of H. pylori. Estimates of risks and costs were obtained from published literature. Since the efficacy of H. pylori therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis.Results: PCR screening was cost-effective and had an incremental-cost effectiveness ratio per quality adjusted life-year (QALY) of $38,591.89 when compared to 13C-UBT strategy with an ICER of $2373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced peptic ulcer disease risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model.Conclusion: Our modeling study finds PCR screening and treating of H. pylori to be cost-effective in the prevention of gastric cancer and peptic ulcer disease. However, the potential negative consequences of H. pylori eradication such as antibiotic resistance could change the balance of benefits of population screening.

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