Helicobacter pylori infection has been identified as a risk factor for certain types of gastric cancer. However, the extent to which H pylori eradication decreases the risk of gastric cancer is unknown, raising the question of whether population-based H pylori screening should be undertaken.
To compare clinical and economic effects of H pylori screening, with and without confirmatory testing, with no screening to prevent gastric cancer.
Decision analysis incorporating a Markov simulation.
Simulated cohorts of men and women with varying risk of gastric cancer.
Three strategies were evaluated: (1) no screening; (2) H pylori serologic testing, treat those positive for H pylori, no follow-up testing; and (3) H pylori serologic testing, treat those positive for H pylori, followed by a test to confirm H pylori eradication, re-treat those who test positive. In the principal analysis, the risk of gastric cancer after H pylori eradication was assumed to be similar to that for those without H pylori infection. Scenarios with less optimistic assumptions regarding risk reduction of cancer were evaluated.
Main Outcome Measures
Gastric cancer rates, discounted cost per life-year saved.
If H pylori eradication reduced the risk of cancer to that of people never infected, both H pylori intervention strategies reduced gastric cancer rates so that each yielded at least 12 additional life-years per 1000 40-year-old white men screened when compared with no screening. Helicobacterpylori serologic testing without posttreatment confirmatory testing resulted in the lowest cost per additional life-year saved ($6264). The cost-effectiveness of the H pylori screening strategies varied substantially as the level of risk reduction of cancer was varied, but remained cost-effective even at moderate rates (<30%) of excess risk reduction of cancer in all cohorts evaluated.
Population-based H pylori screening has the potential to produce important health benefits at a reasonable cost at moderate rates of excess risk reduction of cancer. Controlled studies are necessary to confirm and quantify the impact of H pylori eradication on the risk of gastric cancer.