Abstract
ObjectivesRefugees and immigrants from developing countries settling in industrialised countries have a high prevalence of Helicobacter pylori (H. pylori). Screening these groups for H. pylori and use of eradication therapy to reduce the future burden of gastric cancer and peptic ulcer disease is not currently recommended in most countries. We investigated whether a screening and eradication approach would be cost effective in high prevalence populations.MethodsNine different screening and follow-up strategies for asymptomatic immigrants from high H. pylori prevalence areas were compared with the current approach of no screening. Cost effectiveness comparisons assumed population prevalence's of H. pylori of 25%, 50% or 75%. The main outcome measure was the net cost for each cancer prevented for each strategy. Total costs of each strategy and net costs including savings from reductions in ulcers and gastric cancer were also calculated.ResultsStool antigen testing with repeat testing after treatment was the most cost effective approach relative to others, for each prevalence value. The net cost per cancer prevented with this strategy was US$111,800 (assuming 75% prevalence), $132,300 (50%) and $193,900 (25%). A test and treat strategy using stool antigen remained relatively cost effective, even when the prevalence was 25%.Conclusions H. pylori screening and eradication can be an effective strategy for reducing rates of gastric cancer and peptic ulcers in high prevalence populations and our data suggest that use of stool antigen testing is the most cost effective approach.
Highlights
Estimates suggest that half of the world’s population is infected with H. pylori
H. pylori is a major causative agent in the development of gastric cancer [1], and cancer occurs in 0.1–3% of those chronically infected [1]
Gastric cancer is the second most common cause of cancer death worldwide leading to 736,000 deaths annually [2], including 11000 in the United States [3]
Summary
Estimates suggest that half of the world’s population is infected with H. pylori. Sero-prevalence studies in lower and middle income countries show rates of exposure above 80% [1]. Colonisation persists for decades and is potentially lifelong, leading to chronic gastrointestinal inflammation, and stomach and duodenal ulcers. H. pylori is a major causative agent in the development of gastric cancer [1], and cancer occurs in 0.1–3% of those chronically infected [1]. Gastric cancer is the second most common cause of cancer death worldwide leading to 736,000 deaths annually [2], including 11000 in the United States [3]. The mean 5 year net cost of a patient with gastric cancer is over 50000 [4], and the five year survival rate is less than 20% [5]. Eradication of H. pylori has been shown to reduce progression to precancerous changes in the stomach [6], and to reduce the risk of developing gastric cancer by approximately one third [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
