Cost effectiveness analysis of population-based serology screening and (13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer: a markov model.
OBJECTIVE
To compare the costs and effectiveness of no screening and no eradication therapy, the population-based Helicobacter pylori (H pylori) serology screening with eradication therapy and (13)C-Urea breath test (UBT) with eradication therapy.


METHODS
A Markov model simulation was carried out in all 237900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses.


RESULTS
Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16166 per life year saved or $13571 per QALY gained for the serology screening, and $38792 per life year saved and $32525 per QALY gained for the UBT. The ICER was $477079 per life year saved or $390337 per QALY gained for the UBT compared to the serology screening. The cost-effectiveness of serology screening over the UBT was robust to most parameters in the model.


CONCLUSIONS
The population-based serology screening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.
Xie
Feng
F
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8P 1H1, Canada. fengxie@mamaster.ca
Luo
Nan
N
Lee
Hin-Peng
HP
D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001944:Breath Tests; D002247:Carbon Isotopes; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D012698:Serologic Tests / Q000191:economics*; D012846:Singapore; D013274:Stomach Neoplasms / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*; D014508:Urea / Q000191:economics*
D000900:Anti-Bacterial Agents; D002247:Carbon Isotopes; D014508:Urea