1. A screening program to test and treat for Helicobacter pylori infection: Cost-utility analysis by age, sex and ethnicity.
- Author
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Teng, Andrea M., Kvizhinadze, Giorgi, Nair, Nisha, McLeod, Melissa, Wilson, Nick, and Blakely, Tony
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HELICOBACTER pylori infections , *DIAGNOSIS , *INDIGENOUS peoples , *UNCERTAINTY , *ANTIBIOTICS , *HELICOBACTER disease diagnosis , *MEDICAL screening , *MEDICAL care cost statistics , *COST effectiveness , *ETHNIC groups , *HELICOBACTER diseases , *HELICOBACTER pylori , *PROBABILITY theory , *QUALITY-adjusted life years , *STOMACH tumors , *STATISTICAL models , *DISEASE complications , *PREVENTION , *ECONOMICS - Abstract
Background: The World Health Organization recommends all countries consider screening for H. pylori to prevent gastric cancer. We therefore aimed to estimate the cost-effectiveness of a H. pylori serology-based screening program in New Zealand, a country that includes population groups with relatively high gastric cancer rates.Methods: A Markov model was developed using life-tables and morbidity data from a national burden of disease study. The modelled screening program reduced the incidence of non-cardia gastric cancer attributable to H. pylori, if infection was identified by serology screening, and for the population expected to be reached by the screening program. A health system perspective was taken and detailed individual-level costing data was used.Results: For adults aged 25-69 years old, nation-wide screening for H. pylori was found to have an incremental cost of US$196 million (95% uncertainty interval [95% UI]: $182-$211 million) with health gains of 14,200 QALYs (95% UI: 5,100-26,300). Cost per QALY gained was US$16,500 ($7,600-$38,400) in the total population and 17% (6%-29%) of future gastric cancer cases could be averted with lifetime follow-up. A targeted screening program for Māori only (indigenous population), was more cost-effective at US$8,000 ($3,800-$18,500) per QALY.Conclusions: This modeling study found that H. pylori screening was likely to be cost-effective in this high-income country, particularly for the indigenous population. While further research is needed to help clarify the precise benefits, costs and adverse effects of such screening programs, there seems a reasonable case for policy-makers to give pilot programs consideration, particularly for any population groups with relatively elevated rates of gastric cancer. [ABSTRACT FROM AUTHOR]- Published
- 2017
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