This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (43)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Diagnosis  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

A. Mark Fendrick, MD; Michael E. Chernew, PhD; Richard A. Hirth, PhD; Bernard S. Bloom, PhD; Rajesh R. Bandekar, PhD; James M. Scheiman, MD

Arch Intern Med. 1999;159:142-148.

Background  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.

Objective  To compare clinical and economic effects of H pylori screening, with and without confirmatory testing, with no screening to prevent gastric cancer.

Design  Decision analysis incorporating a Markov simulation.

Patients  Simulated cohorts of men and women with varying risk of gastric cancer.

Intervention  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.

Results  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. Helicobacter pylori 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.

Conclusions  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.

The authors' affiliations appear in the acknowledgment section at the end of the article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Review: Eradication of Helicobacter pylori to prevent gastroduodenal diseases: Hitting more than one bird with the same stone
Lee et al.
Therapeutic Advances in Gastroenterology 2008;1:111-120.
ABSTRACT  

Cost-effectiveness Analysis between Primary and Secondary Preventive Strategies for Gastric Cancer
Lee et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:875-885.
ABSTRACT | FULL TEXT  

The time to eradicate gastric cancer is now
Graham and Shiotani
Gut 2005;54:735-738.
ABSTRACT | FULL TEXT  

Helicobacter pylori Infection and Gastric Cancer--For Want of More Outcomes
Parsonnet and Forman
JAMA 2004;291:244-245.
FULL TEXT  

Helicobacter pylori Eradication and Gastric Preneoplastic Conditions: A Randomized, Double-Blind, Placebo-Controlled Trial
Ley et al.
Cancer Epidemiol. Biomarkers Prev. 2004;13:4-10.
ABSTRACT | FULL TEXT  

Effect of Helicobacter pylori eradication on development of dyspeptic and reflux disease in healthy asymptomatic subjects
Vaira et al.
Gut 2003;52:1543-1547.
ABSTRACT | FULL TEXT  

Helicobacter pylori and Interleukin 1 Genotyping: An Opportunity to Identify High-Risk Individuals for Gastric Carcinoma
Figueiredo et al.
JNCI J Natl Cancer Inst 2002;94:1680-1687.
ABSTRACT | FULL TEXT  

Helicobacter pylori-Related Disease: Guidelines for Testing and Treatment
Peterson et al.
Arch Intern Med 2000;160:1285-1291.
ABSTRACT | FULL TEXT  

Helicobacter pylori and Gastric Cancer: Both Primary and Secondary Preventive Measures Are Required
Rugge et al.
Arch Intern Med 1999;159:2483-2484.
FULL TEXT