H Pylori
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 21, 2008; 14(19): 3021-3027
Published online May 21, 2008. doi: 10.3748/wjg.14.3021
Cost effectiveness analysis of population-based serology screening and 13C-Urea breath test for Helicobacter pylori to prevent gastric cancer: A markov model
Feng Xie, Nan Luo, Hin-Peng Lee
Feng Xie, Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario L8P1H1, Canada
Nan Luo, Department of Community, Occupational, and Family Medicine, and Research Fellow, Centre for Health Services Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Hin-Peng Lee, Department of Community, Occupational, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Author contributions: Xie F designed the study, analysized the data and wrote the manuscript; Luo N designed the study and revised the manuscript; and Lee HP revised the manuscript.
Correspondence to: Feng Xie, Dr, Programs for Assessment of Technology in Health (PATH), Department of Clinical Epidemiology and Biostatistics, McMaster University, 25 Main Street West Suite 2000, Hamilton, Ontario L8P 1H1, Canada. fengxie@mamaster.ca
Telephone: +1-905-5237284
Fax: +1-905-5220568
Received: September 27, 2007
Revised: April 9, 2008
Published online: May 21, 2008
Abstract

AIM: To compare the costs and effectiveness of no screening and no eradication therapy, the population-based Helicobacter pylori (H pylori) serology screening with eradication therapy and 13C-Urea breath test (UBT) with eradication therapy.

METHODS: A Markov model simulation was carried out in all 237 900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses.

RESULTS: Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16 166 per life year saved or $13 571 per QALY gained for the serology screening, and $38 792 per life year saved and $32 525 per QALY gained for the UBT. The ICER was $477 079 per life year saved or $390 337 per QALY gained for the UBT compared to the serology screening. The cost-effectiveness of serology screening over the UBT was robust to most parameters in the model.

CONCLUSION: The population-based serology screening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.

Keywords: Cost-effectiveness analysis; Gastric cancer; Helicobacter pylori; 13C-Urea breath test; Serology