Department of Gastroenterology and Hepatology, People's Hospital of Zhengzhou University, and Henan Provincial People's Hospital, Zhengzhou, Henan, China.
Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, Shanghai, China.
Helicobacter. 2022 Aug;27(4):e12911. doi: 10.1111/hel.12911. Epub 2022 Jun 15.
Helicobacter pylori (H. pylori) infection and its related diseases are substantial public health burden for highly infected areas. Recently, a novel family-based H. pylori infection control and management (FBCM) strategy is introduced for H. pylori infection prevention and control. However, its cost-effectiveness has not been evaluated. We conducted this health economic evaluation to investigate the cost-effectiveness of FBCM, screen-and-treat, and no-screen strategies in Chinese population.
Cost-effectiveness analysis was performed using decision tree and Markov model. Parameters required for the model were from published literatures and public databases, including health state utility, screening characteristics, treatment effectiveness, and medical costs for the three strategies. Outcomes were cost, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER). Uncertainty analysis was performed to verify the robustness of this model.
To prevent gastric cancer in a cohort of 1 million asymptomatic Chinese families, FBCM and screen-and-treat strategies prevented 1010 and 1201 new gastric cancer cases, reduced 2809 and 3339 gastric cancer-related death, and saved 956,971 and 1,137,549 QALYs, respectively, when compared with no-screen strategy. Cost-effectiveness analysis showed that FBCM strategy cost $9.18/QALY, and screen-and-treat strategy cost $12.08/QALY for gastric cancer prevention when compared with no-screen strategy. One-way sensitivity analysis revealed that screening from younger age by both strategies are more cost-effective. When compared with FBCM strategy, screen-and-treat strategy saved 5.98% gastric cancer cases and 5.78% of gastric cancer deaths, but costed $9348 to reduce a gastric cancer case. Results are not sensitive to any variables, and probabilistic sensitivity analysis confirmed robustness of the results.
Both FBCM and screen-and-treat strategies are cost-effective for gastric cancer prevention compared with no-screen strategy. Since FBCM is more practical and convenient, it may be an efficient and excellent cost-effective strategy for gastric cancer prevention in H. pylori and gastric cancer prevalent areas.
幽门螺杆菌（H. pylori）感染及其相关疾病是高感染地区的重大公共卫生负担。最近，一种新的基于家庭的 H. pylori 感染控制和管理（FBCM）策略被引入用于 H. pylori 感染的预防和控制。然而，其成本效益尚未得到评估。我们进行了这项健康经济学评价，以调查 FBCM、筛查和治疗以及不筛查策略在中国人群中的成本效益。
使用决策树和马尔可夫模型进行成本效益分析。模型所需的参数来自已发表的文献和公共数据库，包括三种策略的健康状态效用、筛查特征、治疗效果和医疗费用。结果是成本、质量调整生命年（QALY）和增量成本效益比（ICER）。进行不确定性分析以验证该模型的稳健性。
为了预防 100 万例中国无症状家庭的胃癌，FBCM 和筛查和治疗策略分别预防了 1010 例和 1201 例新的胃癌病例，减少了 2809 例和 3339 例胃癌相关死亡，并分别节省了 956971 和 1137549 QALY，与不筛查策略相比。成本效益分析表明，与不筛查策略相比，FBCM 策略预防胃癌的成本为每 QALY 9.18 美元，筛查和治疗策略的成本为每 QALY 12.08 美元。单因素敏感性分析表明，两种策略对更年轻人群进行筛查更具成本效益。与 FBCM 策略相比，筛查和治疗策略节省了 5.98%的胃癌病例和 5.78%的胃癌死亡，但每减少一个胃癌病例需要花费 9348 美元。结果对任何变量均不敏感，概率敏感性分析证实了结果的稳健性。
与不筛查策略相比，FBCM 和筛查和治疗策略在预防胃癌方面均具有成本效益。由于 FBCM 更实用和方便，因此它可能是 H. pylori 和胃癌高发地区预防胃癌的一种高效、卓越的成本效益策略。
