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Cost-effectiveness analysis of Helicobacter pylori screening in prevention of gastric cancer in Chinese

Published online by Cambridge University Press:  24 January 2008

Feng Xie ,
Nan Luo ,
Gord Blackhouse ,
Ron Goeree  and
Hin-Peng Lee
Feng Xie
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
Nan Luo
Affiliation:
National University of Singapore
Gord Blackhouse
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
Ron Goeree
Affiliation:
McMaster University and St. Joseph's Healthcare Hamilton
Hin-Peng Lee
Affiliation:
National University of Singapore
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Abstract

Objectives: The aim of this study was to evaluate the costs and effectiveness associated with no screening, Helicobacter pylori serology screening, and the 13C-urea breath test (UBT) for gastric cancer in the Chinese population.

Methods: A Markov model simulation was carried out in Singaporean Chinese at 40 years of age (n = 478,500) from the perspective of public healthcare providers. The main outcome measures were costs, number of gastric cancer cases prevented, life-years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation.

Results: The ICER of serology screening versus no screening was $25,881 per QALY gained (95 percent confidence interval (95 percent CI), $5,700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95 percent CI, $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY.

Conclusions: It cannot be confidently concluded that either H pylori screening was a cost-effective strategy compared with no screening in all Chinese at the age of 40 years. Nevertheless, serology screening has demonstrated much more potential to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.

Keywords

Cost-effectiveness analysisGastric cancerHelicobacter pyloriMarkov modelMonte Carlo simulation
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 1 , January 2008 , pp. 87 - 95
Copyright
Copyright © Cambridge University Press 2008

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