Cost-effectiveness of adding a Helicobacter pylori antibody test to the upper gastrointestinal series in gastric cancer screening at the workplace.

Objective: Helicobacter pylori infections increase gastric cancer risk. Detecting and eradicating Helicobacter pylori infections and implementing a follow-up strategy should be considered by occupational health practitioners. This study aimed to evaluate the cost-effectiveness of adding an H. pylori antibody (HPA) test to current gastric cancer screening using upper gastrointestinal series (UGI) at the workplace in Japan.

Methods: The data of Japanese people aged ≥40 years were collected from PubMed and evaluated in two cohorts: UGI (X-ray examination)+HPA test and UGI only. A Markov model was used for the cost-effectiveness analysis of the UGI+HPA test and UGI-only cohorts. The main outcomes were cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The impact of uncertainty was assessed using one-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA).

Results: A base-case analysis showed that the UGI+HPA test strategy was less costly (-US＄1,039 and -US＄1,496) and more effective (0.415 and 0.437 QALYs) than the UGI-only strategy in the 40- and 50-year-old groups, respectively. The UGI+HPA test strategy was assessed as a dominant strategy. In the OWSA, the tornado diagram showed negative expected costs and positive QALY gains within the established ranges for all parameters. In the PSA, more than 95% of the simulations demonstrated ICER <5 million yen (US＄51,674; US＄1=96.76 yen)/QALY.

Conclusions: This modeling study suggests that gastric cancer screening using UGI+HPA test followed by eradication and annual opportunistic screening, compared with UGI only, resulted in lower costs and greater QALY gains for both 40- and 50-year-old groups at the workplace.