title: Using stool antigen to screen for Helicobacter pylori in immigrants and refugees from high prevalence countries is relatively cost effective in reducing the burden of gastric cancer and peptic ulceration.
abstract: OBJECTIVE
  Refugees and immigrants from developing countries settling in industrialised countries have a high prevalence of Helicobacter pylori (H. pylori). Screening these groups for H. pylori and use of eradication therapy to reduce the future burden of gastric cancer and peptic ulcer disease is not currently recommended in most countries. We investigated whether a screening and eradication approach would be cost effective in high prevalence populations.
  
  
  METHODS
  Nine different screening and follow-up strategies for asymptomatic immigrants from high H. pylori prevalence areas were compared with the current approach of no screening. Cost effectiveness comparisons assumed population prevalence's of H. pylori of 25%, 50% or 75%. The main outcome measure was the net cost for each cancer prevented for each strategy. Total costs of each strategy and net costs including savings from reductions in ulcers and gastric cancer were also calculated.
  
  
  RESULTS
  Stool antigen testing with repeat testing after treatment was the most cost effective approach relative to others, for each prevalence value. The net cost per cancer prevented with this strategy was US$111,800 (assuming 75% prevalence), $132,300 (50%) and $193,900 (25%). A test and treat strategy using stool antigen remained relatively cost effective, even when the prevalence was 25%.
  
  
  CONCLUSIONS
  H. pylori screening and eradication can be an effective strategy for reducing rates of gastric cancer and peptic ulcers in high prevalence populations and our data suggest that use of stool antigen testing is the most cost effective approach.
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Schulz
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia; Centre for Population Health, Burnet Institute Prahran, Victoria, Australia.
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Leder
authors.affiliation: Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, University of Melbourne, at the Doherty Institute, Melbourne, Victoria, Australia.
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
mesh_terms: D000942:Antigens, Bacterial / Q000032:analysis*; D001315:Australia; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D054242:Emigrants and Immigrants; D005243:Feces / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016480:Helicobacter pylori / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D015233:Models, Statistical; D010437:Peptic Ulcer / Q000191:economics* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control; D015995:Prevalence; D012036:Refugees; D013274:Stomach Neoplasms / Q000191:economics* / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000942:Antigens, Bacterial