Economic evaluation of preventing gastric cancer by eliminating Helicobacter pylori infection in China.

Abstract

Objective: To analyze the cost-effectiveness of screening Helicobacter pylori (H. pylori) and determine the optimal screening strategy in China.

Methods: A Markov model was used to assess the cost-effectiveness of 13 screen-and-treat strategies, varying starting ages (20, 30, 40) and screening frequencies (no screening, once per lifetime, every 2, 3, or 5 years until age 50). For each scenario, 1,000,000 individuals were simulated. Outcomes were costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and the number needed to treat (NNT) to prevent a gastric cancer. Deterministic and probabilistic sensitivity analyses tested the model's robustness.

Results: Compared with no screening, screening at 20, 30, and 40 years of age once per lifetime were all cost-effective, with ICERs of -$40.37, -$78.28, and -$135.69 per QALY gained, respectively. NNT of the three strategies were 72, 63, and 55. Screening with a high frequency was associated with higher cost and QALYs; in the probabilistic sensitivity analyses, no matter the initial screening age, screening every 2 years would be the optimal strategy.

Conclusion: Screening for H. pylori is a cost-saving and effective way to prevent gastric cancer in China. To prevent more gastric cancer, the population should take an H. pylori test from the age of 20 with a frequency of every 5 years in low gastric cancer incidence areas or age, with a frequency of every 2 years in high gastric cancer incidence areas or age.