A Population-Based Helicobacter pylori Eradication Strategy Is More Cost-Effective than Endoscopic Screening

Akiko Kowada, Akiko Kowada

Abstract

Background: Helicobacter pylori (HP) eradication therapy is an efficient primary prevention method to reduce gastric cancer development. In Japan, biennial endoscopic screening for individuals aged 50 years and older is currently conducted as a national gastric cancer prevention program.

Aims: We aimed to evaluate which strategy was the most optimal and cost-effective among HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening as a national gastric cancer prevention program.

Methods: We developed a state-transition model for HP eradication strategy, annual, biennial, and triennial endoscopic screening, and no screening using a healthcare payer perspective and a lifetime horizon. We targeted a hypothetical cohort of the Japanese population in their 20 s to 80 s. The main outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, gastric cancer cases, and deaths from gastric cancer. We performed one-way, two-way, and probabilistic sensitivity analyses.

Results: HP eradication strategy was more cost-effective than endoscopic screening at any interval in all age groups. Cost-effectiveness was sensitive to HP infection rate. Cost-effective acceptability curves by Monte Carlo simulations for 10,000 trials demonstrated that HP eradication strategy was 100% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained in all age groups. Over a lifetime, HP eradication strategy saves US$28.07 billion, increases 37.16 million QALYs, prevents 4.47 million gastric cancer cases, and saves 319,870 lives from gastric cancer.

Conclusion: A population-based HP eradication strategy is optimal and cost-effective for a national gastric cancer prevention program in Japan, replacing the current secondary prevention-focused biennial endoscopic screening.

Keywords: Disease eradication; Endoscopy; Health economics; Helicobacter pylori; Primary prevention; Stomach neoplasms.

Conflict of interest statement

The author has no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Schematic depiction of a Markov cycle tree in a state-transition model. We show the health states in the model as ovals. In a yearly model cycle, transitions can occur between the health states and other health states, represented by the arrows. HPHelicobacter pylori
Fig. 2
Fig. 2
One-way, two-way and probabilistic sensitivity analyses. a The ICER tornado diagram for HP eradication strategy versus no screening in 20-year-old individuals. b The ICER tornado diagram for HP eradication strategy versus biennial endoscopic screening in 50-year-old individuals. c Two-way sensitivity analysis plot for age baseline versus HP infection rate in the 20 s to 40 s age groups. Colors represent the different strategies for the combination of the 2 parameters at a WTP threshold of US$50,000 per QALY gained based on the net monetary benefit. d Two-way sensitivity analysis plot for age baseline versus HP infection rate in the 50 s to 80 s age groups. e Cost-effectiveness acceptability curve. ICER incremental cost-effectiveness ratio, HP Helicobacter pylori, QALY quality-adjusted life-year, WTP willingness-to-pay
Fig. 2
Fig. 2
One-way, two-way and probabilistic sensitivity analyses. a The ICER tornado diagram for HP eradication strategy versus no screening in 20-year-old individuals. b The ICER tornado diagram for HP eradication strategy versus biennial endoscopic screening in 50-year-old individuals. c Two-way sensitivity analysis plot for age baseline versus HP infection rate in the 20 s to 40 s age groups. Colors represent the different strategies for the combination of the 2 parameters at a WTP threshold of US$50,000 per QALY gained based on the net monetary benefit. d Two-way sensitivity analysis plot for age baseline versus HP infection rate in the 50 s to 80 s age groups. e Cost-effectiveness acceptability curve. ICER incremental cost-effectiveness ratio, HP Helicobacter pylori, QALY quality-adjusted life-year, WTP willingness-to-pay

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