Cost-effectiveness analysis of Helicobacter pylori screening in prevention of gastric cancer in Chinese

Int J Technol Assess Health Care. Winter 2008;24(1):87-95. doi: 10.1017/S0266462307080117.

Abstract

Objectives: The aim of this study was to evaluate the costs and effectiveness associated with no screening, Helicobacter pylori serology screening, and the 13C-urea breath test (UBT) for gastric cancer in the Chinese population.

Methods: A Markov model simulation was carried out in Singaporean Chinese at 40 years of age (n = 478,500) from the perspective of public healthcare providers. The main outcome measures were costs, number of gastric cancer cases prevented, life-years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation.

Results: The ICER of serology screening versus no screening was $25,881 per QALY gained (95 percent confidence interval (95 percent CI), $5,700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95 percent CI, $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY.

Conclusions: It cannot be confidently concluded that either H pylori screening was a cost-effective strategy compared with no screening in all Chinese at the age of 40 years. Nevertheless, serology screening has demonstrated much more potential to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.

MeSH terms

  • Adult
  • Breath Tests
  • Cost-Benefit Analysis
  • Helicobacter pylori / isolation & purification*
  • Humans
  • Markov Chains
  • Mass Screening / economics*
  • Monte Carlo Method
  • Quality-Adjusted Life Years
  • Singapore / epidemiology
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / prevention & control*