title: A screening program to test and treat for Helicobacter pylori infection: Cost-utility analysis by age, sex and ethnicity.
abstract: The World Health Organization recommends all countries consider screening for H. pylori to prevent gastric cancer. We therefore aimed to estimate the cost-effectiveness of a H. pylori serology-based screening program in New Zealand, a country that includes population groups with relatively high gastric cancer rates.
  
  
  
  A Markov model was developed using life-tables and morbidity data from a national burden of disease study. The modelled screening program reduced the incidence of non-cardia gastric cancer attributable to H. pylori, if infection was identified by serology screening, and for the population expected to be reached by the screening program. A health system perspective was taken and detailed individual-level costing data was used.
  
  
  
  For adults aged 25-69 years old, nation-wide screening for H. pylori was found to have an incremental cost of US$196 million (95% uncertainty interval [95% UI]: $182-$211 million) with health gains of 14,200 QALYs (95% UI: 5,100-26,300). Cost per QALY gained was US$16,500 ($7,600-$38,400) in the total population and 17% (6%-29%) of future gastric cancer cases could be averted with lifetime follow-up. A targeted screening program for Māori only (indigenous population), was more cost-effective at US$8,000 ($3,800-$18,500) per QALY.
  
  
  
  This modeling study found that H. pylori screening was likely to be cost-effective in this high-income country, particularly for the indigenous population. While further research is needed to help clarify the precise benefits, costs and adverse effects of such screening programs, there seems a reasonable case for policy-makers to give pilot programs consideration, particularly for any population groups with relatively elevated rates of gastric cancer.
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand. andrea.teng@otago.ac.nz.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Teng
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Giorgi
authors.initials: G
authors.lastname: Kvizhinadze
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Nisha
authors.initials: N
authors.lastname: Nair
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: McLeod
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Tony
authors.initials: T
authors.lastname: Blakely
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005006:Ethnicity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D009520:New Zealand / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D013274:Stomach Neoplasms / Q000191:economics / Q000208:ethnology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cost-effectiveness; Cost-utility analysis; Gastric cancer; Screening program; Serology