OBJECTIVES: The aim of this study was to evaluate the costs and effectiveness associated with no screening, Helicobacter pylori serology screening, and the 13C-urea breath test (UBT) for gastric cancer in the Chinese population. METHODS: A Markov model simulation was carried out in Singaporean Chinese at 40 years of age (n = 478,500) from the perspective of public healthcare providers. The main outcome measures were costs, number of gastric cancer cases prevented, life-years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation. RESULTS: The ICER of serology screening versus no screening was $25,881 per QALY gained (95 percent confidence interval (95 percent CI), $5,700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95 percent CI, $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY. CONCLUSIONS: It cannot be confidently concluded that either H pylori screening was a cost-effective strategy compared with no screening in all Chinese at the age of 40 years. Nevertheless, serology screening has demonstrated much more potential to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.
OBJECTIVES: The aim of this study was to evaluate the costs and effectiveness associated with no screening, Helicobacter pylori serology screening, and the 13C-urea breath test (UBT) for gastric cancer in the Chinese population. METHODS: A Markov model simulation was carried out in Singaporean Chinese at 40 years of age (n = 478,500) from the perspective of public healthcare providers. The main outcome measures were costs, number of gastric cancer cases prevented, life-years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation. RESULTS: The ICER of serology screening versus no screening was $25,881 per QALY gained (95 percent confidence interval (95 percent CI), $5,700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95 percent CI, $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY. CONCLUSIONS: It cannot be confidently concluded that either H pylori screening was a cost-effective strategy compared with no screening in all Chinese at the age of 40 years. Nevertheless, serology screening has demonstrated much more potential to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.
Authors: M Dinis-Ribeiro; M Areia; A C de Vries; R Marcos-Pinto; M Monteiro-Soares; A O'Connor; C Pereira; P Pimentel-Nunes; R Correia; A Ensari; J M Dumonceau; J C Machado; G Macedo; P Malfertheiner; T Matysiak-Budnik; F Megraud; K Miki; C O'Morain; R M Peek; T Ponchon; A Ristimaki; B Rembacken; F Carneiro; E J Kuipers Journal: Virchows Arch Date: 2011-12-22 Impact factor: 4.064
Authors: M Dinis-Ribeiro; M Areia; A C de Vries; R Marcos-Pinto; M Monteiro-Soares; A O'Connor; C Pereira; P Pimentel-Nunes; R Correia; A Ensari; J M Dumonceau; J C Machado; G Macedo; P Malfertheiner; T Matysiak-Budnik; F Megraud; K Miki; C O'Morain; R M Peek; T Ponchon; A Ristimaki; B Rembacken; F Carneiro; E J Kuipers Journal: Endoscopy Date: 2011-12-23 Impact factor: 10.093