title: Cost-effectiveness of screening and treating Helicobacter pylori for gastric cancer prevention.
abstract: Gastric cancer is the second leading cause of cancer-related death worldwide. A meta-analysis of seven randomized controlled trials concluded that Helicobacter pylori eradication reduces gastric cancer incidence by 35%. Current consensus is that H. pylori screening and treatment is cost-effective only in high-risk populations. This paper provides an up-to-date overview of the evidence for cost-effectiveness of H. pylori screening and treatment in different population settings and risk levels for H. pylori infection. Ten unique cost-effectiveness or cost-utility analyses were identified. All found that screening for H. pylori to prevent gastric cancer in the general population costs less than $50,000 per LYG. This finding was robust for differences in H. pylori prevalence, gender and ethnicity. Based on limited evidence, re-treatment (for treatment failure), repeated screening, limiting screening and treatment to those with the CagA phenotype, or universal treatment, does not appear to be cost-effective. However, most included studies failed to consider both the broader benefits as well as the adverse effects of widespread use of antibiotics for H. pylori.
authors.affiliation: Department of Public Health, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Electronic address: i.vogelaar@erasmusmc.nl.
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D013274:Stomach Neoplasms / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cost–benefit analysis; Early detection of cancer; Helicobacter pylori; Stomach neoplasms