Oh Aaron, Truong Han, Kim Judith, Rustgi Sheila D, Abrams Julian A, Hur Chin
Albert Einstein College of Medicine, Bronx, NY, USA.
Harvard University, Cambridge, MA, USA.
J Gastrointest Oncol. 2022 Oct;13(5):2186-2196. doi: 10.21037/jgo-21-911.
() is a major risk factor for gastric cancer. Screening and treatment of may reduce the risk of gastric cancer and peptic ulcer disease (PUD). Polymerase chain reaction (PCR) of gastric biopsies provides superior sensitivity and specificity for the detection of . This study explores whether population-based screening with PCR is cost-effective in the US.
A Markov cohort state-transition model was developed to compare three strategies: no screening with opportunistic eradication, C-UBT population screening and treating of , and PCR population screening and treating of . Estimates of risks and costs were obtained from published literature. Since the efficacy of therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis.
PCR screening was cost-effective and had an incremental-cost effectiveness ratio per quality adjusted life-year (QALY) of $38,591.89 when compared to C-UBT strategy with an ICER of $2,373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced PUD risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model.
Our modeling study finds PCR screening and treating of to be cost-effective in the prevention of gastric cancer and PUD. However, the potential negative consequences of eradication such as antibiotic resistance could change the balance of benefits of population screening.
（幽门螺杆菌）是胃癌的主要危险因素。幽门螺杆菌的筛查和治疗可降低胃癌和消化性溃疡疾病（PUD）的风险。胃活检的聚合酶链反应（PCR）对幽门螺杆菌的检测具有更高的敏感性和特异性。本研究探讨在美国基于人群的幽门螺杆菌PCR筛查是否具有成本效益。
建立了一个马尔可夫队列状态转换模型，以比较三种策略：不进行筛查但进行机会性根除、基于碳-尿素呼气试验（C-UBT）的人群筛查并治疗幽门螺杆菌、基于PCR的人群筛查并治疗幽门螺杆菌。风险和成本估计来自已发表的文献。由于幽门螺杆菌治疗在预防胃癌方面的疗效尚不确定，我们在敏感性分析中广泛地将效益范围设定为30%-100%。
与C-UBT策略相比，PCR筛查具有成本效益，每质量调整生命年（QALY）的增量成本效益比为38,591.89美元，C-UBT策略的ICER为每QALY 2,373.43美元。与不进行筛查相比，基于PCR的人群筛查将累积胃癌发病率从0.84%降至0.74%，并将消化性溃疡疾病风险从14.8%降至6.0%。PCR筛查的成本效益对模型中的大多数参数都很稳健。
我们的模型研究发现，对幽门螺杆菌进行PCR筛查和治疗在预防胃癌和消化性溃疡疾病方面具有成本效益。然而，根除幽门螺杆菌的潜在负面后果，如抗生素耐药性，可能会改变人群筛查的效益平衡。
