Authors' objectives:

The objective of the study was to develop a discrete-event simulation model to evaluate the cost-effectiveness of population screening for H. pylori in England and Wales to prevent both gastric cancer and peptic ulcer disease.

Authors' results and conclusions: Population screening would involve screening approximately 25 million individuals if uptake was 70%, with over 5 million people being treated. The number of deaths prevented falls with increasing age at screening, but so does the present value of costs because there would be less prevalent screening and costs are deferred. In the base case the cost-effectiveness of H. pylori screening improves with age and is under 10,000 GBP per life-year saved (LYS) for all age groups, though over an 80-year follow-up. Lowering the discount rate for benefits significantly improves the cost/LYS to under 2,000 GBP in all groups. Increasing the time lag for reversion of gastric cancer risk to 20 years or increasing the level of opportunistic eradication reduces the relative advantage for screening. Screening at age 40 might be the most pragmatic policy, balancing cost-effectiveness and the feasibility of screening. The cost/LYS for the base run at age 40 is 5,866 GBP falling to 1,027 GBP if the benefit is discounted at 1.5%. Screening by serology is more cost-effective than using the urea breath test. Using a less efficacious but cheaper eradication regimen is as cost-effective but with fewer deaths prevented. The cost-effectiveness is sensitive to the H. pylori prevalence, lag time, relative risk, cohort estimate and compliance. Moreover, cost/LYS rises to over 20,000 GBP if there is a high level of opportunistic eradication of H. pylori in patients presenting with dyspepsia and a reduced efficacy of eradication on gastric cancer risk. The benefits of screening take time to accrue and are very sensitive to the discount rate. At 6% rates the cost-effectiveness does not fall below 20,000 GBP for 30 years.

Authors' recommendations: Population screening for H. pylori is likely to be cost-effective with a cost/LYS of under 10,000 GBP for the base assumptions, which compares favourably with other screening programmes. However the benefits take time to accrue and this cost/LYS is over an 80-year follow-up. Once-only screening at age 40 with a prevalent round for people aged 40-49 appears to be the most pragmatic policy. A major uncertainty is the effect of eradication of H. pylori on gastric cancer risk. The cost-effectiveness of H. pylori screening would be reduced if there were extensive H. pylori opportunistic testing of all dyspeptic individuals presenting to primary care.

Authors' methods: Decision-analysis model

Project Status: Completed

URL for project: http://www.hta.ac.uk/1012

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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