Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: a mandate for clinical trials.
BACKGROUND
It is unknown whether eradication of Helicobacter pylori infection prevents development of gastric adenocarcinoma. To determine whether screening and treatment trials are warranted, we conducted a cost-effectiveness analysis to estimate the costs and benefits associated with screening for H pylori at age 50 and treating those individuals infected with antibiotics.


METHODS
We compared two interventions: (1) screen for H pylori and treat those with a positive test, and (2) do not screen and do not treat. Estimates of risks and costs were obtained by review of published reports. Since the efficacy of H pylori therapy in cancer prevention is unknown, we did sensitivity analyses, varying this estimate widely. In our base-case analysis, we assumed that H pylori treatment prevented 30% of attributable gastric cancers.


RESULTS
In the base-case analysis, 11,646,000 persons in the US would be screened and 4,658,400 treated, at a cost of $996 million. Cost-effectiveness was $25,000 per year of life saved. Cost-effectiveness was sensitive to the efficacy of the cancer prevention strategy. At low efficacy rates (< 10%), the screening programme was more expensive (> $75,000 per year of life saved). In a high-risk group such as Japanese-Americans, however, screening and treatment required less than $50,000 per year of life saved, even at 5% treatment efficacy.


CONCLUSIONS
Screening and treatment for H pylori infection is potentially cost-effective in the prevention of gastric cancer, particularly in high-risk populations. Cancer prevention trials are strongly recommended.
Parsonnet
J
J
Department of Medicine, Stanford University School of Medicine, CA 94305, USA.
Harris
R A
RA
Hack
H M
HM
Owens
D K
DK
D000230:Adenocarcinoma / Q000517:prevention & control*; D016022:Case-Control Studies; D002986:Clinical Trials as Topic / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D012107:Research Design; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology