Helicobacter pylori test-and-treat program can be cost-effective to prevent gastric cancer in Taiwanese adults: referred to the nationwide reimbursement database.
BACKGROUND
Helicobacter pylori infection increases the risk of gastric cancer. The study aimed to compare cost-effectiveness ratios of H. pylori test-and-treat programs to prevent gastric cancer in Taiwan, referring to the nationwide reimbursement database and expected years of life lost.


METHODS
During 1998-2009, there were 12,857 females and 24,945 males with gastric adenocarcinoma in Taiwan National Cancer Registry. They were followed up to 2010 and linked to the reimbursement database of National Health Insurance and the national mortality registry to determine lifetime health expenditures and expected years of life lost. Cost-effectiveness ratios of H. pylori test-and-treat programs for prevention of gastric adenocarcinoma were compared between screenings with (13) C-urea breath test and with anti-H. pylori IgG.


RESULTS
The test-and-treat program with anti-H. pylori IgG to prevent gastric adenocarcinoma had lower incremental cost-effectiveness ratios than that with (13) C-urea breath test in both sexes (females: 244 vs 1071 US dollars/life-year; males: 312 vs 1431 US dollars/life-year). Cost saving would be achieved in an endemic area where H. pylori prevalence was >73.5%, or by selecting subpopulations with high absolute risk reduction rates of cancer after eradication. Moreover, expected years of life lost of gastric adenocarcinoma were higher and the incremental cost-effectiveness ratios of test-and-treat programs were more cost-effective in young adults (30-69 y/o) than in elders (≥70 y/o).


CONCLUSIONS
The test-and-treat program with anti-H. pylori IgG shall be cost-effective to prevent gastric adenocarcinoma in a high endemic area, especially beginning at 30 years of age when H. pylori prevalence rates become stabilized.
Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Hsiu-Chi
HC
Cheng
Jung-Der
JD
Wang
Wei-Ying
WY
Chen
Chian-Wei
CW
Chen
Shun-Chiao
SC
Chang
Bor-Shyang
BS
Sheu
D000230:Adenocarcinoma / Q000191:economics / Q000517:prevention & control; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D004359:Drug Therapy, Combination / Q000191:economics* / Q000379:methods; D005260:Female; D005102:Health Expenditures; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests / Q000191:economics / Q000379:methods; D013274:Stomach Neoplasms / Q000191:economics* / Q000517:prevention & control*; D013624:Taiwan
Helicobacter pylori; Stomach neoplasms; cost-effectiveness analysis; prevention and control