Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-26T17:00:03.788Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Nan Luo ,
Gord Blackhouse ,
Ron Goeree  and
Hin-Peng Lee
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Cost-effectiveness analysisGastric cancerHelicobacter pyloriMarkov modelMonte Carlo simulation
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 1 , January 2008 , pp. 87 - 95
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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;20:1603–1609.CrossRefGoogle Scholar
2. Briggs, A, Sculpher, M. An introduction to Markov modelling for economic evaluation. Pharmacoeconomics. 1998;13:397–409.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;6:327–340.3.0.CO;2-W>CrossRefGoogle ScholarPubMed
4. Crew, KD, Neugut, AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–362.CrossRefGoogle ScholarPubMed
5. Crowe, SE. Helicobacter infection, chronic inflammation, and the development of malignancy. Curr Opin Gastroenterol. 2005;21:32–38.Google ScholarPubMed
6. Dan, YY, So, JB, Yeoh, KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol. 2006;4:709–716.CrossRefGoogle ScholarPubMed
7. Danese, S, Armuzzi, A, Romano, A, et al. . Efficacy and tolerability of antibiotics in patients undergoing H. pylori eradication. Hepatogastroenterology. 2001;48:465–467.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;94:2373–2379.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;159:142–148.CrossRefGoogle ScholarPubMed
11. Fenwick, E, Byford, S. A guide to cost-effectiveness acceptability curves. Br J Psychiatry. 2005;187:106–108.CrossRefGoogle ScholarPubMed
12. Fock, KM. Helicobacter pylori infection–current status in Singapore. Ann Acad Med Singapore. 1997;26:637–641.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;302:1302–1305.CrossRefGoogle ScholarPubMed
14. Forman, D, Webb, P, Parsonnet, J. H pylori and gastric cancer. Lancet. 1994;343:243–244.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;25:133–141.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;35:763–767.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;12:655–659.CrossRefGoogle ScholarPubMed
18. Kelley, JR, Duggan, JM. Gastric cancer epidemiology and risk factors. J Clin Epidemiol. 2003;56:1–9.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;356:37–42.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;13:1–12.CrossRefGoogle Scholar
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;10:569–572.CrossRefGoogle ScholarPubMed
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; 1996:214–246.CrossRefGoogle Scholar
23. Miwa, H, Go, MF, Sato, N. H. pylori and gastric cancer: The Asian enigma. Am J Gastroenterol. 2002;97:1106–1112.CrossRefGoogle ScholarPubMed
24. Parsonnet, J, Friedman, GD, Vandersteen, DP, et al. . Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991;325:1127–1131.CrossRefGoogle ScholarPubMed
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;348:150–154.CrossRefGoogle ScholarPubMed
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;10:148–156.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;13:322–338.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;93:1909–1913.CrossRefGoogle ScholarPubMed
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;341:1359–1362.CrossRefGoogle Scholar
32. Tian, J, Wang, XD, Chen, ZC. Survival of patients with stomach cancer in Changle city of China. World J Gastroenterol. 2004;10:1543–1546.CrossRefGoogle ScholarPubMed
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;24:135–139.Google ScholarPubMed
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;102:857–862.Google ScholarPubMed