基于人群的幽门螺杆菌筛查和根除的成本效益：最佳实施年龄。

Cost-Effectiveness of Population-Based Helicobacter pylori Screening With Eradication for Optimal Age of Implementation.

机构信息

Department of Occupational Health, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan.

Advanced Research Promotion Center, Health Sciences University of Hokkaido, Ishikari-Gun, Hokkaido, Japan.

出版信息

Helicobacter. 2024 Jul-Aug;29(4):e13120. doi: 10.1111/hel.13120.

DOI:10.1111/hel.13120

PMID:39138610

Abstract

BACKGROUND

Helicobacter pylori screening with eradication reduces gastric cancer (GC) development. However, it was unknown at what age the H. pylori screening should be implemented to achieve the greatest benefits at the least cost. This study aimed to determine the optimal age of H. pylori screening for primary GC prevention.

MATERIALS AND METHODS

A state transition model for a hypothetical cohort of 15-year-olds from a healthcare payer perspective on a lifetime horizon was developed. Nine ages for H. pylori testing were considered: 15, 18, 20, 30, 40, 50, 60, 70, and 80 years. H. pylori screening was compared with no screening and annual, biennial, and triennial endoscopies starting at age 50. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios, GC cases, stage I GC cases, and GC-related deaths. One-way, two-way, and probabilistic sensitivity analyses were performed to assess the uncertainty of the parameters.

RESULTS

All H. pylori screenings at ages 15-80 were more cost-effective than all endoscopies and no screening. H. pylori screening at age 15 yielded the greatest cost-saving and benefits. The cost-effectiveness was sensitive to the adherence rate of H. pylori screening at age 15. Cost-effectiveness acceptability curves showed that H. pylori screening at age 15 was 99.6% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained. Compared with no screening and biennial endoscopy in 15.6 million 15-year-olds from 2022 to 2037, respectively, H. pylori screening at age 15 saves US$9.70 million and US$2.39 billion, increases 1.26 million QALYs with 1312 LYs and 651 LYs, prevents 436 GC cases with 254 stage I GC cases and 305 stage I GC cases, and avoids 176 GC-related deaths and 72 GC-related deaths.

CONCLUSIONS

The optimal age for population-based H. pylori screening at ages 15-80 is the youngest, 15 years old. Shifting population-based H. pylori screening to younger people will reduce GC morbidity and mortality worldwide, along with a detailed investigation of the feasibility and long-term consequences of H. pylori eradication at a young age.

摘要

背景

根除幽门螺杆菌（H. pylori）筛查可降低胃癌（GC）的发生风险。然而，目前尚不清楚 H. pylori 筛查应在哪个年龄段实施，才能以最小的成本获得最大的效益。本研究旨在确定 H. pylori 筛查用于原发性 GC 预防的最佳年龄。

材料和方法

从医疗保健支付者的角度出发，基于终身视角，针对 15 岁人群建立了一个状态转移模型。考虑了 9 个 H. pylori 检测年龄：15、18、20、30、40、50、60、70 和 80 岁。将 H. pylori 筛查与不筛查以及从 50 岁开始每年、每两年和每三年进行内镜检查进行比较。主要结局为成本、质量调整生命年（QALYs）、预期寿命生命年（LYs）、增量成本效益比、GC 病例、I 期 GC 病例和 GC 相关死亡。进行了单因素、双因素和概率敏感性分析，以评估参数的不确定性。

结果

所有年龄在 15-80 岁之间的 H. pylori 筛查均优于所有内镜检查和不筛查。15 岁时进行 H. pylori 筛查可节省最多的成本并带来最大的收益。H. pylori 筛查在 15 岁时的依从率对成本效益具有敏感性。成本效益可接受性曲线表明，在愿意支付每获得一个质量调整生命年（QALY）50000 美元的阈值下，15 岁时进行 H. pylori 筛查的成本效益为 99.6%。与 2022 年至 2037 年分别对 1560 万 15 岁人群进行不筛查和每两年进行一次内镜检查相比，15 岁时进行 H. pylori 筛查可节省 9700 万美元和 239 亿美元，增加 126 万个 QALYs，增加 1312 个 LYs 和 651 个 LYs，预防 436 例 GC 病例，其中 254 例为 I 期 GC 病例和 305 例为 I 期 GC 病例，避免 176 例 GC 相关死亡和 72 例 GC 相关死亡。