Yeh Jennifer M, Kuntz Karen M, Ezzati Majid, Goldie Sue J
Department of Health Policy and Management, Program in Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA.
Int J Cancer. 2009 Jan 1;124(1):157-66. doi: 10.1002/ijc.23864.
Gastric cancer is the second leading cause of cancer-related deaths worldwide. Treatment for Helicobacter pylori infection, the leading causal risk factor, can reduce disease progression, but the long-term impact on cancer incidence is uncertain. Using the best available data, we estimated the potential health benefits and economic consequences associated with H. pylori screening in a high-risk region of China. An empirically calibrated model of gastric cancer was used to project reduction in lifetime cancer risk, life-expectancy and costs associated with (i) single lifetime screening (age 20, 30 or 40); (ii) single lifetime screening followed by rescreening individuals with negative results and (iii) universal treatment for H. pylori (age 20, 30 or 40). Data were from the published literature and national and international databases. Screening and treatment for H. pylori at age 20 reduced the mean lifetime cancer risk by 14.5% (men) to 26.6% (women) and cost less than $1,500 per year of life saved (YLS) compared to no screening. Rescreening individuals with negative results and targeting older ages was less cost-effective. Universal treatment prevented an additional 1.5% to 2.3% of risk reduction, but incremental cost-effectiveness ratios exceeded $2,500 per YLS. Screening young adults for H. pylori could prevent one in every 4 to 6 cases of gastric cancer in China and would be considered cost-effective using the GDP per capita threshold. These results illustrate the potential promise of a gastric cancer screening program and provide rationale for urgent clinical studies to move the prevention agenda forward.
胃癌是全球癌症相关死亡的第二大主要原因。幽门螺杆菌感染是主要的致病风险因素，对其进行治疗可降低疾病进展，但对癌症发病率的长期影响尚不确定。我们利用现有最佳数据，估计了在中国一个高风险地区进行幽门螺杆菌筛查相关的潜在健康益处和经济后果。使用一个经过实证校准的胃癌模型来预测与以下情况相关的终生癌症风险降低、预期寿命和成本：（i）单次终生筛查（20岁、30岁或40岁）；（ii）单次终生筛查，随后对结果为阴性的个体进行重新筛查；以及（iii）对幽门螺杆菌进行普遍治疗（20岁、30岁或40岁）。数据来自已发表的文献以及国家和国际数据库。与不进行筛查相比，20岁时对幽门螺杆菌进行筛查和治疗可使男性终生癌症平均风险降低14.5%，女性降低26.6%，且每挽救一年生命（YLS）的成本低于1500美元。对结果为阴性的个体进行重新筛查并针对老年人的做法成本效益较低。普遍治疗可额外预防1.5%至2.3%的风险降低，但每YLS的增量成本效益比超过2500美元。在中国，对年轻人进行幽门螺杆菌筛查可预防每4至6例胃癌中的1例，按照人均国内生产总值阈值衡量，将被视为具有成本效益。这些结果说明了胃癌筛查项目的潜在前景，并为推动预防议程的紧急临床研究提供了依据。
