Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: a mandate for clinical trials

• Published in: The Lancet (British edition) Vol. 348; no. 9021; pp. 150 - 154
• Main Authors: Parsonnet, Julie, Harris, Ryan A, Hack, Howard M, Owens, Douglas K
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 20.07.1996; Lancet; Elsevier Limited
• Subjects: Adenocarcinoma - prevention & control; Antibiotics; Bacteria; Biological and medical sciences; Cancer; Case-Control Studies; Clinical Trials as Topic - economics; Cost analysis; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Support Techniques; Digestive system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Helicobacter Infections - drug therapy; Helicobacter Infections - economics; Helicobacter Infections - epidemiology; Helicobacter Infections - prevention & control; Helicobacter pylori; Humans; Male; Mass Screening - economics; Medical sciences; Middle Aged; Models, Economic; Prevention; Preventive medicine; Research Design; Sensitivity analysis; Sensitivity and Specificity; Stomach Neoplasms - prevention & control; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; United States - epidemiology; United States; Human; Stomach; Spirillales; Spirillaceae; Malignant tumor; Medical screening; Infection; Prevention; Treatment; Helicobacter pylori; Bacteriosis; Digestive diseases; Bacteria; Gastric disease; Cost efficiency analysis
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(96)01501-2

It is unknown whether eradication of Helicobacter pylori infection prevents development of gastric adenocarcinoma. To determine whether screening and treatment trials are warranted, we conducted a cost-effectiveness analysis to estimate the costs and benefits associated with screening for H pylori at age 50 and treating those individuals infected with antibiotics. We compared two interventions: (1) screen for H pylori and treat those with a positive test, and (2) do not screen and do not treat. Estimates of risks and costs were obtained by review of published reports. Since the efficacy of H pylori therapy in cancer prevention is unknown, we did sensitivity analyses, varying this estimate widely. In our base-case analysis, we assumed that H pylori treatment prevented 30% of attributable gastric cancers. In the base-case analysis, 11 646 000 persons in the US would be screened and 4 658 400 treated, at a cost of $996 million. Cost-effectiveness was $25 000 per year of life saved. Cost-effectiveness was sensitive to the efficacy of the cancer prevention strategy. At low efficacy rates (<10%), the screening programme was more expensive (>$75 000 per year of life saved). In a high-risk group such as Japanese-Americans, however, screening and treatment required less than $50 000 per year of life saved, even at 5% treatment efficacy. Screening and treatment for H pylori infection is potentially cost-effective in the prevention of gastric cancer, particularly in high-risk populations. Cancer prevention trials are strongly recommended.