Cost-effectiveness analysis of Helicobacter pylori screening in prevention of gastric cancer in Chinese.
OBJECTIVE
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.
Xie
Feng
F
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada. fengxie@mcmaster.ca
Luo
Nan
N
Blackhouse
Gord
G
Goeree
Ron
R
Lee
Hin-Peng
HP
D000328:Adult; D001944:Breath Tests; D003362:Cost-Benefit Analysis; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D012846:Singapore / Q000453:epidemiology; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000517:prevention & control*