 |
|
Clinical and Economic Effects of Population-Based Helicobacter pylori Screening to Prevent Gastric Cancer
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.
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
|
