Cost-Effectiveness of Population-Based Helicobacter pylori Screening With Eradication for Optimal Age of Implementation

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-08-13 DOI:10.1111/hel.13120

Akiko Kowada

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引用次数: 0

Abstract

Background

Helicobacter pylori screening with eradication reduces gastric cancer (GC) development. However, it was unknown at what age the H. pylori screening should be implemented to achieve the greatest benefits at the least cost. This study aimed to determine the optimal age of H. pylori screening for primary GC prevention.

Materials and Methods

A state transition model for a hypothetical cohort of 15-year-olds from a healthcare payer perspective on a lifetime horizon was developed. Nine ages for H. pylori testing were considered: 15, 18, 20, 30, 40, 50, 60, 70, and 80 years. H. pylori screening was compared with no screening and annual, biennial, and triennial endoscopies starting at age 50. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios, GC cases, stage I GC cases, and GC-related deaths. One-way, two-way, and probabilistic sensitivity analyses were performed to assess the uncertainty of the parameters.

Results

All H. pylori screenings at ages 15–80 were more cost-effective than all endoscopies and no screening. H. pylori screening at age 15 yielded the greatest cost-saving and benefits. The cost-effectiveness was sensitive to the adherence rate of H. pylori screening at age 15. Cost-effectiveness acceptability curves showed that H. pylori screening at age 15 was 99.6% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained. Compared with no screening and biennial endoscopy in 15.6 million 15-year-olds from 2022 to 2037, respectively, H. pylori screening at age 15 saves US$9.70 million and US$2.39 billion, increases 1.26 million QALYs with 1312 LYs and 651 LYs, prevents 436 GC cases with 254 stage I GC cases and 305 stage I GC cases, and avoids 176 GC-related deaths and 72 GC-related deaths.

Conclusions

The optimal age for population-based H. pylori screening at ages 15–80 is the youngest, 15 years old. Shifting population-based H. pylori screening to younger people will reduce GC morbidity and mortality worldwide, along with a detailed investigation of the feasibility and long-term consequences of H. pylori eradication at a young age.

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基于人群的幽门螺旋杆菌筛查的成本效益与最佳实施年龄的根除效果。

背景：幽门螺杆菌筛查和根除可降低胃癌（GC）发病率。然而，幽门螺杆菌筛查应在什么年龄进行才能以最小的成本获得最大的益处，目前尚不清楚。本研究旨在确定幽门螺杆菌筛查在胃癌一级预防中的最佳年龄：从医疗支付方的角度出发，建立了一个假设的 15 岁人群终生的状态转换模型。考虑了幽门螺杆菌检测的九个年龄段：15、18、20、30、40、50、60、70 和 80 岁。幽门螺杆菌筛查与不做筛查以及从 50 岁开始每年、每两年和每三年做一次内窥镜检查进行了比较。主要结果包括成本、质量调整生命年 (QALY)、预期寿命 (LY)、增量成本效益比、GC 病例、I 期 GC 病例以及 GC 相关死亡病例。为评估参数的不确定性，进行了单向、双向和概率敏感性分析：结果：与所有内窥镜检查和不做筛查相比，15-80 岁年龄段的所有幽门螺杆菌筛查更具成本效益。15岁时进行幽门螺杆菌筛查的成本节约和效益最大。成本效益对 15 岁幽门螺杆菌筛查的坚持率很敏感。成本效益可接受性曲线显示，在每QALY收益50,000美元的支付意愿阈值下，15岁时进行幽门螺杆菌筛查的成本效益为99.6%。与2022年至2037年不进行幽门螺杆菌筛查和每两年对1560万名15岁儿童进行内镜检查相比，15岁进行幽门螺杆菌筛查可分别节省970万美元和23.9亿美元，增加126万QALYs（1312 LYs和651 LYs），预防436例GC病例（254例I期GC病例和305例I期GC病例），避免176例GC相关死亡和72例GC相关死亡：结论：15-80 岁人群幽门螺杆菌筛查的最佳年龄为 15 岁。将基于人群的幽门螺杆菌筛查转移到年轻人身上将在全球范围内降低 GC 发病率和死亡率，同时对在年轻人中根除幽门螺杆菌的可行性和长期后果进行详细调查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.