Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: A mandate for clinical trials
Modelling cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: A mandate for clinical trials
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DOI：
10.1016/s0140-6736(96)01501-2
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发表时间：
1996-07-20
期刊：
影响因子：
168.9
通讯作者：
Owens, DK
中科院分区：
文献类型：
--
作者：
Parsonnet, J;Harris, RA;Owens, DK
背景根除幽门螺杆菌感染是否能预防胃腺癌的发生尚不清楚。为了确定筛查和治疗试验是否有必要，我们进行了成本效益分析，以估计50岁幽门螺杆菌筛查和抗生素治疗相关的成本和收益。方法比较两种干预措施：(1)筛查幽门螺杆菌并治疗阳性休息者，(2)不筛查不治疗。风险和费用的估计是通过审查已发表的报告得出的。由于幽门螺杆菌治疗在预防癌症方面的疗效尚不清楚，我们进行了敏感性分析，并广泛地改变了这一估计。在我们的基本病例分析中，我们假设幽门螺杆菌治疗可以预防30%的可归因胃癌。在基本病例分析中，美国将有1164.6万人接受筛查，4658400人接受治疗，费用为9.96亿美元。成本效益为每年挽救生命25,000美元，成本效益对癌症预防策略的效果很敏感。在低有效率的情况下（每年挽救生命7.5万美元），然而，在日裔美国人等高危人群中，即使在5%的治疗效果下，筛查和治疗每年挽救生命所需的费用不到5万美元。解释筛查和治疗幽门螺杆菌感染在预防胃癌方面具有潜在的成本效益，特别是在高危人群中。强烈建议进行癌症预防试验。
Background It is unknown whether eradication of Helicobacter pyiori infection prevents development of gastric adenocarcinoma. To determine whether screening and treatment trials are warranted, we conducted a cost-effectiveness analysis to estimate the costs and benefits associated 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 obtained by review of published reports. Since the efficacy of H pyiori therapy in cancer prevention is unknown, we did sensitivity analyses, varying this estimate widely. In our base-case analysis, we assumed that H pylori treatment prevented 30% of attributable gastric cancers.Findings In the base-case analysis, 11 646 000 persons in the US would be screened and 4 658 400 treated, at a cost of $996 million. Cost-effectiveness was $25 000 per year of life saved, Cost-effectiveness was sensitive to the efficacy of the cancer prevention strategy. At low efficacy rates ($75 000 per year of life saved), In a high-risk group such as Japanese-Americans, however, screening and treatment required less than $50 000 per year of life saved, even at 5% treatment efficacy.Interpretation Screening and treatment for H pyiori infection is potentially cost-effective in the prevention of gastric cancer, particularly in high-risk populations. Cancer prevention trials are strongly recommended.