title: Cost-effectiveness analysis between primary and secondary preventive strategies for gastric cancer.
abstract: OBJECTIVE
  The present study is done to assess the relative cost-effectiveness, optimal initial age, and interscreening interval between primary and secondary prevention strategies for gastric cancer.
  
  
  METHODS
  Base-case estimates, including variables of natural history, efficacy of intervention, and relevant cost, were derived from two preventive programs targeting a high-risk population. Cost-effectiveness was compared between chemoprevention with (13)C urea breath testing followed by Helicobacter pylori (H. pylori) eradication and high-risk surveillance based on serum pepsinogen measurement and confirmed by endoscopy. The main outcome measure was cost per life-year gained with a 3% annual discount rate.
  
  
  RESULTS
  The incremental cost-effectiveness ratio (ICER) for once-only chemoprevention at age 30 years versus no screening was U.S. $17,044 per life-year gained. Eradication of H. pylori at later age or with a periodic scheme yielded a less favorable result. Annual high-risk screening at age of 50 years versus no screening resulted in an ICER of U.S. $29,741 per life-year gained. The ICERs of surveillance did not substantially vary with different initial ages or interscreening intervals. Chemoprevention could be dominated by high-risk surveillance when the initial age was older than 44 years. Otherwise, chemoprevention was more cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness was most sensitive to the infection rate of H. pylori and proportion of early gastric cancer in all detectable cases.
  
  
  CONCLUSIONS
  Early H. pylori eradication once in lifetime seems more cost-effective than surveillance strategy. However, the choice is still subject to the risk of infection, detectability of early gastric cancer, and timing of intervention.
authors.affiliation: Institute of Preventive Medicine and Division of Biostatistics, Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Room 521, No. 17, Hsu-Chow Road, 100 Taipei, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Lee
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Wu
authors.forename: Tzeng-Ying
authors.initials: TY
authors.lastname: Liu
authors.forename: Ming-Fang
authors.initials: MF
authors.lastname: Yen
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Chiu
authors.forename: Hsiu-Po
authors.initials: HP
authors.lastname: Wang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Tony
authors.initials: T
authors.lastname: Hsiu-Hsi Chen
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001944:Breath Tests; D018890:Chemoprevention / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening; D008875:Middle Aged; D011322:Primary Prevention / Q000191:economics*; D013274:Stomach Neoplasms / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology