School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
Helicobacter. 2024 Jul-Aug;29(4):e13123. doi: 10.1111/hel.13123.
There is an economic evaluation on the family-based Helicobacter pylori screen-and-treat strategy (FBHS) in China. This study aimed to compare the cost-effectiveness of the FBHS with the traditional H. pylori screen-and-treat strategy (TBHS).
A seven-state microsimulation model, including H. pylori infection and gastric cancer states, was constructed on the basis of the target family samples from 29 provinces in China. Taking a lifetime horizon from a healthcare system perspective, the long-term costs and health outcomes of the FBHS and TBHS screening strategies were simulated separately, and economic evaluations were performed. The model parameters were primarily derived from real-world data, published literature, and expert opinions. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost/quality-adjusted life-year (QALY) gained. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were performed to assess the uncertainty of the results.
The base-case analysis revealed that the average costs for FBHS and TBHS were 563.67 CNY and 574.08 CNY, respectively, with corresponding average QALYs of 14.83 and 14.79. The ICER for the comparison between the two strategies was -214.07, indicating that FBHS was an absolutely dominant strategy with better cost-effectiveness. The results of both one-way sensitivity analysis and probabilistic sensitivity analysis were robust. When taking into account the added benefit of the higher H. pylori eradication rate in FBHS, the average costs were further reduced, and the average QALYs were increased, solidifying its position as an unequivocally dominant strategy.
The FBHS is an absolutely dominant and cost-effective strategy that enables an optimized allocation of screening resources. Decision-makers should prioritize FBHS when developing H. pylori prevention and control strategies.
对基于家庭的幽门螺杆菌筛查和治疗策略（FBHS）进行经济学评价。本研究旨在比较 FBHS 与传统幽门螺杆菌筛查和治疗策略（TBHS）的成本效益。
基于中国 29 个省份目标家庭样本，构建了一个包含幽门螺杆菌感染和胃癌状态的七状态微观模拟模型。从医疗保健系统的角度来看，采用终生时间范围，分别模拟 FBHS 和 TBHS 筛查策略的长期成本和健康结果，并进行经济评价。模型参数主要来源于真实世界数据、已发表文献和专家意见。主要结果是增量成本效益比（ICER），表示为每获得一个质量调整生命年（QALY）的成本。进行了单因素敏感性分析、概率敏感性分析和情景分析，以评估结果的不确定性。
基于案例分析表明，FBHS 和 TBHS 的平均成本分别为 563.67 CNY 和 574.08 CNY，相应的平均 QALY 分别为 14.83 和 14.79。两种策略比较的 ICER 为-214.07，表明 FBHS 是一种具有更好成本效益的绝对优势策略。单因素敏感性分析和概率敏感性分析的结果均具有稳健性。当考虑到 FBHS 中幽门螺杆菌根除率较高所带来的附加益处时，平均成本进一步降低，平均 QALY 增加，进一步证实了其作为明确优势策略的地位。
FBHS 是一种绝对优势且具有成本效益的策略，可以优化筛查资源的分配。决策者在制定幽门螺杆菌防控策略时应优先考虑 FBHS。
