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Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation

Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation
Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation
Objectives: To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales.
Methods: A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYS) for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken.
Results: The cost/LYS from screening at age 40 years was ?5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded ?20 000 over an 80-year follow-up, but did for shorter periods.
Conclusions: H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.
148-156
Roderick, P.
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Davies, R.
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Raftery, J.
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Crabbe, D.
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Pearce, R.
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Patel, P.
244cc88b-5b33-43f8-93d8-2656943ad0c4
Bhandari, P.
0c3eea04-e00f-4a2f-b4ba-f50f451b419b
Roderick, P.
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Davies, R.
e978c85d-11eb-43e3-8db0-39334aa4b8d9
Raftery, J.
f7af69fc-5be9-4d95-88e0-5b5f7aeec60b
Crabbe, D.
e2ce72df-ec20-4d65-a0b8-45313673dfb1
Pearce, R.
7e1130ae-22e7-41a7-9fa1-93b3f6ca4a2c
Patel, P.
244cc88b-5b33-43f8-93d8-2656943ad0c4
Bhandari, P.
0c3eea04-e00f-4a2f-b4ba-f50f451b419b

Roderick, P., Davies, R., Raftery, J., Crabbe, D., Pearce, R., Patel, P. and Bhandari, P. (2003) Cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease, using simulation. Journal of Medical Screening, 10 (3), 148-156. (doi:10.1258/096914103769011067).

Record type: Article

Abstract

Objectives: To evaluate the cost-effectiveness of population screening for Helicobacter pylori in preventing gastric cancer and peptic ulcer disease in England and Wales.
Methods: A discrete event simulation model used parameter estimates, derived from peer-reviewed literature, routine data and statistical modelling. Population screening was compared with no screening but with opportunistic eradication in patients presenting with dyspepsia. Costs included screening, eradication and costs averted to provide costs per life years saved (cost/LYS) for preventing gastric cancer and peptic ulcer disease. Sensitivity analyses were undertaken.
Results: The cost/LYS from screening at age 40 years was ?5860 at discount rates of 6%. The outcomes were sensitive to H. pylori prevalence, the degree of opportunistic eradication, the discount rate, the efficacy of eradication on gastric cancer risk, the risk of complicated peptic ulcer disease and gastric cancer associated with H. pylori infection, and the duration of follow-up. In sensitivity analyses, the cost/LYS rarely exceeded ?20 000 over an 80-year follow-up, but did for shorter periods.
Conclusions: H. pylori screening may be cost-effective in the long term. However, before screening can be recommended further evidence is needed to resolve some of the uncertainties, particularly over the efficacy of eradication on risk of gastric cancer, the risk associated with complicated peptic ulcers, and the effect of more widespread opportunistic testing of patients with dyspepsia.

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Published date: 2003

Identifiers

Local EPrints ID: 24489
URI: http://eprints.soton.ac.uk/id/eprint/24489
PURE UUID: e5d86241-ad73-4eee-b890-ec1a0fefb28a
ORCID for P. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

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Date deposited: 31 Mar 2006
Last modified: 16 Mar 2024 02:48

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Contributors

Author: P. Roderick ORCID iD
Author: R. Davies
Author: J. Raftery
Author: D. Crabbe
Author: R. Pearce
Author: P. Patel
Author: P. Bhandari

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