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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
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

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.

Type
GENERAL ESSAYS
Copyright
Copyright © Cambridge University Press 2008

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References

1. Ang, TL, Fock, KM, Dhamodaran, S, et al. . Racial differences in Helicobacter pylori, serum pepsinogen and gastric cancer incidence in an urban Asian population. J Gastroenterol Hepatol. 2005;20:16031609.CrossRefGoogle Scholar
2. Briggs, A, Sculpher, M. An introduction to Markov modelling for economic evaluation. Pharmacoeconomics. 1998;13:397409.CrossRefGoogle ScholarPubMed
3. Briggs, AH, Wonderling, DE, Mooney, CZ. Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327340.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
4. Crew, KD, Neugut, AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354362.CrossRefGoogle Scholar
5. Crowe, SE. Helicobacter infection, chronic inflammation, and the development of malignancy. Curr Opin Gastroenterol. 2005;21:3238.Google Scholar
6. Dan, YY, So, JB, Yeoh, KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol. 2006;4:709716.CrossRefGoogle ScholarPubMed
7. Danese, S, Armuzzi, A, Romano, A, et al. . Efficacy and tolerability of antibiotics in patients undergoing H. pylori eradication. Hepatogastroenterology. 2001;48:465467.Google ScholarPubMed
8. Department of Statistics. Yearbook of statistics Singapore. Singapore: Department of Statistics; 2007.Google Scholar
9. Eslick, GD, Lim, LL, Byles, JE, et al. . Association of Helicobacter pylori infection with gastric carcinoma: A meta-analysis. Am J Gastroenterol. 1999;94:23732379.CrossRefGoogle ScholarPubMed
10. Fendrick, AM, Chernew, ME, Hirth, RA, et al. . Clinical and economic effects of population-based Helicobacter pylori screening to prevent gastric cancer. Arch Intern Med. 1999;159:142148.CrossRefGoogle Scholar
11. Fenwick, E, Byford, S. A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005;187:106108.CrossRefGoogle ScholarPubMed
12. Fock, KM. Helicobacter pylori infection–current status in Singapore. Ann Acad Med Singapore. 1997;26:637641.Google ScholarPubMed
13. Forman, D, Newell, DG, Fullerton, F, et al. . Association between infection with Helicobacter pylori and risk of gastric cancer: Evidence from a prospective investigation. BMJ. 1991;302:13021305.CrossRefGoogle ScholarPubMed
14. Forman, D, Webb, P, Parsonnet, J. H pylori and gastric cancer. Lancet. 1994;343:243244.CrossRefGoogle ScholarPubMed
15. Fuccio, L, Zagari, RM, Minardi, ME, Bazzoli, F. Systematic review: Helicobacter pylori eradication for the prevention of gastric cancer. Aliment Pharmacol Ther. 2007;25:133141.CrossRefGoogle ScholarPubMed
16. Gambaro, C, Bilardi, C, Dulbecco, P, et al. . Comparable Helicobacter pylori eradication rates obtained with 4- and 7-day rabeprazole-based triple therapy: A preliminary study. Dig Liver Dis. 2003;35:763767.CrossRefGoogle ScholarPubMed
17. Kang, JY, Yeoh, KG, Ho, KY, et al. . Racial differences in Helicobacter pylori seroprevalence in Singapore: Correlation with differences in peptic ulcer frequency. J Gastroenterol Hepatol. 1997;12:655659.CrossRefGoogle ScholarPubMed
18. Kelley, JR, Duggan, JM. Gastric cancer epidemiology and risk factors. J Clin Epidemiol. 2003;56:19.CrossRefGoogle ScholarPubMed
19. Koga, S, Kaibara, N, Kishimoto, H, et al. Comparison of 5- and 10-year survival rates in operated gastric cancer patients. Assessment of the 5-year survival rate as a valid indicator of postoperative curability. Langenbecks Arch Chir. 1982;356:3742.CrossRefGoogle ScholarPubMed
20. Lam, SK, Talley, NJ. Report of the 1997 Asia Pacific Consensus Conference on the management of Helicobacter pylori infection. J Gastroenterol Hepatol. 1998;13:112.CrossRefGoogle ScholarPubMed
21. Lee, HS, Gwee, KA, Teng, LY, et al. . Validation of [13C]urea breath test for Helicobacter pylori using a simple gas chromatograph-mass selective detector. Eur J Gastroenterol Hepatol. 1998;10:569572.CrossRefGoogle Scholar
22. Lipscomb, J, Weinstein, MC, Torrance, GW. Time preference. In: Gold, MR, Siegel, JE, Russell, JE, Weinstein, MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996:214246.Google Scholar
23. Miwa, H, Go, MF, Sato, N. H. pylori and gastric cancer: The Asian enigma. Am J Gastroenterol. 2002;97:11061112.CrossRefGoogle Scholar
24. Parsonnet, J, Friedman, GD, Vandersteen, DP, et al. . Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991;325:11271131.CrossRefGoogle Scholar
25. Parsonnet, J, Harris, RA, Hack, HM, Owens, DK. Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: A mandate for clinical trials. Lancet. 1996;348:150154.CrossRefGoogle Scholar
26. Roderick, P, Davies, R, Raftery, J, et al. . Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation. J Med Screen. 2003;10:148156.CrossRefGoogle ScholarPubMed
27. Seow, A, Koh, WP, Chia, KS, Shi, LM, Lee, HP, Shanmugaratnam, K. Trends in cancer incidence in Singapore 1968–2002. Singapore: Singapore Cancer Registry Report No.6; 2004.Google Scholar
28. Sonnenberg, FA, Beck, JR. Markov models in medical decision making: A practical guide. Med Decis Making. 1993;13:322338.CrossRefGoogle ScholarPubMed
29. Stack, WA, Knifton, A, Thirlwell, D, et al. . Safety and efficacy of rabeprazole in combination with four antibiotic regimens for the eradication of Helicobacter pylori in patients with chronic gastritis with or without peptic ulceration. Am J Gastroenterol. 1998;93:19091913.CrossRefGoogle Scholar
30. The Committee on Epidemic Diseases. Seroprevalence of Helicobacter pylori infection in Singapore. Epidemiol News Bull. 1996;22:31–22.Google Scholar
31. The EUROGAST Study Group. An international association between Helicobacter pylori infection and gastric cancer. Lancet. 1993;341:13591362.CrossRefGoogle ScholarPubMed
32. Tian, J, Wang, XD, Chen, ZC. Survival of patients with stomach cancer in Changle city of China. World J Gastroenterol. 2004;10:15431546.CrossRefGoogle Scholar
33. Wang, Q, Jin, PH, Lin, GW, et al. . Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis. Zhonghua Liu Xing Bing Xue Za Zhi. 2003;24:135139.Google Scholar
34. World Health Organization. Mortality country fact sheet 2006 Singapore. Geneva: World Health Organization; 2006.Google Scholar
35. Yang, KC, Wang, GM, Chen, JH, et al. . Comparison of rabeprazole-based four- and seven-day triple therapy and omeprazole-based seven-day triple therapy for Helicobacter pylori infection in patients with peptic ulcer. J Formos Med Assoc. 2003;102:857862.Google ScholarPubMed
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