Xie Feng, Luo Nan, Lee Hin-Peng
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8P 1H1, Canada.
World J Gastroenterol. 2008 May 21;14(19):3021-7. doi: 10.3748/wjg.14.3021.
To compare the costs and effectiveness of no screening and no eradication therapy, the population-based Helicobacter pylori (H pylori) serology screening with eradication therapy and (13)C-Urea breath test (UBT) with eradication therapy.
A Markov model simulation was carried out in all 237900 Chinese males with age between 35 and 44 from the perspective of the public healthcare provider in Singapore. The main outcome measures were the costs, number of gastric cancer cases prevented, life years saved, and quality-adjusted life years (QALYs) gained from screening age to death. The uncertainty surrounding the cost-effectiveness ratio was addressed by one-way sensitivity analyses.
Compared to no screening, the incremental cost-effectiveness ratio (ICER) was $16166 per life year saved or $13571 per QALY gained for the serology screening, and $38792 per life year saved and $32525 per QALY gained for the UBT. The ICER was $477079 per life year saved or $390337 per QALY gained for the UBT compared to the serology screening. The cost-effectiveness of serology screening over the UBT was robust to most parameters in the model.
The population-based serology screening for H pylori was more cost-effective than the UBT in prevention of gastric cancer in Singapore Chinese males.
比较不进行筛查及根除治疗、基于人群的幽门螺杆菌（H pylori）血清学筛查联合根除治疗以及（13）C-尿素呼气试验（UBT）联合根除治疗的成本与效果。
从新加坡公共医疗服务提供者的角度，对年龄在35至44岁之间的237900名中国男性进行马尔可夫模型模拟。主要结局指标包括成本、预防的胃癌病例数、挽救的生命年数以及从筛查年龄至死亡所获得的质量调整生命年（QALY）。通过单向敏感性分析处理成本效益比的不确定性。
与不进行筛查相比，血清学筛查每挽救1个生命年的增量成本效益比（ICER）为16166美元，每获得1个QALY的ICER为13571美元；UBT每挽救1个生命年的ICER为38792美元，每获得1个QALY的ICER为32525美元。与血清学筛查相比，UBT每挽救1个生命年的ICER为477079美元，每获得1个QALY的ICER为390337美元。血清学筛查相对于UBT的成本效益在模型中的大多数参数下都较为稳健。
在新加坡华裔男性中，基于人群的幽门螺杆菌血清学筛查在预防胃癌方面比UBT更具成本效益。
