MODELING COST-EFFECTIVENESS OF HELICOBACTER-PYLORI SCREENING TO PREVENT GASTRIC-CANCER - A MANDATE FOR CLINICAL-TRIALS

Background It is unknown whether eradication of Helicobacter pyiori in fection prevents development of gastric adenocarcinoma. To determine w hether screening and treatment trials are warranted, we conducted a co st-effectiveness analysis to estimate the costs and benefits associate d with screening for H pylori at age 50 and treating those individuals infected with antibiotics. Methods We compared two interventions: (1) screen for H pylori and treat those with a positive rest, and (2) do not screen and do not treat. Estimates of risks and costs were obtaine d by review of published reports. Since the efficacy of H pyiori thera py in cancer prevention is unknown, we did sensitivity analyses, varyi ng this estimate widely. In our base-case analysis, we assumed that H pylori treatment prevented 30% of attributable gastric cancers. Findin gs In the base-case analysis, 11 646 000 persons in the US would be sc reened and 4 658 400 treated, at a cost of $996 million. Cost-effectiv eness was $25 000 per year of life saved, Cost-effectiveness was sensi tive to the efficacy of the cancer prevention strategy. At low efficac y rates (<10%), the screening programme was more expensive (>$75 000 p er year of life saved), In a high-risk group such as Japanese-American s, however, screening and treatment required less than $50 000 per yea r of life saved, even at 5% treatment efficacy. Interpretation Screeni ng and treatment for H pyiori infection is potentially cost-effective in the prevention of gastric cancer, particularly in high-risk populat ions. Cancer prevention trials are strongly recommended.