Wang Qian, Jin Pi-huan, Lin Guo-wei, Xu San-rong, Chen Jie
Center of Clinical Epidemiology, Huashan Hospital of Fu Dan University, Shanghai 200040, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2003 Feb;24(2):135-9.
Using Markov model Monte Carlo simulation to conduct a cost-effectiveness analysis of screening Helicobacter pylori (H. pylori) infection to prevent gastric cancer.
The Markov model was developed based on the natural course from H. pylori infection to gastric cancer. Two strategies were compared: (1) screening for H. pylori and treatment for those with positive tests, and (2) without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base-case analysis and estimate the confidence interval of cost-effectiveness ratios. The probability sensitivity analysis was used to estimate the cost-effectiveness in multiple uncertainty factors.
Assuming H. pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6% cases of gastric cancer. Cost-effectiveness were 10,405 Yuan (95% CI: 4,238 - 27,727 Yuan) per GC prevented, 64 Yuan (95% CI: 31 - 97 Yuan) per QALY saved and 1,374 Yuan (95% CI: 352 - 86,624 Yuan) per life year saved.
Screening and treatment for H. pylori infection in population was potentially effective in the prevention of gastric cancer, and screening in high incidence area of gastric cancer would be more effective and economic.
运用马尔可夫模型蒙特卡罗模拟法，对筛查幽门螺杆菌（H. pylori）感染以预防胃癌进行成本效益分析。
基于H. pylori感染至胃癌的自然病程建立马尔可夫模型。比较两种策略：（1）筛查H. pylori并对检测呈阳性者进行治疗，（2）不进行筛查和治疗。模型模拟所用数据，包括转移概率、检测和治疗效果，均从相关研究出版物中收集。采用马尔可夫模型蒙特卡罗模拟结合自助法进行基础病例分析，并估计成本效益比的置信区间。概率敏感性分析用于估计多种不确定性因素下的成本效益。
假设根除H. pylori可预防50%的归因胃癌，筛查策略可预防16.6%的胃癌病例。每预防一例胃癌的成本效益为10,405元（95%置信区间：4,238 - 27,727元），每挽救一个质量调整生命年（QALY）的成本效益为64元（95%置信区间：31 - 97元），每挽救一个生命年的成本效益为1,374元（95%置信区间：352 - 86,624元）。
人群中筛查和治疗H. pylori感染对预防胃癌可能有效，在胃癌高发地区进行筛查将更有效且经济。
