Cost-effectiveness of screening and treating Helicobacter pylori for gastric cancer prevention

Abstract

Gastric cancer is second leading cause of cancer-related death worldwide. A meta-analysis of seven randomized controlled trials concluded that H. Pylori eradication reduces gastric cancer incidence by 35%. Current consensus is that H. Pylori screening and treatment is cost-effective only in high-risk populations. This paper provides an up-to-date overview of the evidence for cost-effectiveness of H. Pylori screening and treatment in different population settings and risk levels for H. Pylori infection. Ten unique cost-effectiveness or cost-utility analyses were identified. All found that screening for H. Pylori to prevent gastric cancer in the general population costs less than $50,000 per LYG. This finding was robust for differences in H. Pylori prevalence, gender and ethnicity. Based on limited evidence, re-treatment (for treatment failure), repeated screening, limiting screening and treatment to those with the CagA phenotype, or universal treatment, does not appear to be cost-effective. However, most included studies failed to consider both the broader benefits as well as the adverse effects of widespread use of antibiotics for H. Pylori.

Measuring the societal burden of cancer: The cost of lost productivity due to premature cancer‐related mortality in Europe

“…Similarly, cancer of the cervix uteri that is caused by human papillomavirus (HPV) ranked among the top three most costly sites in Central‐Eastern Europe only. This reveals the societal and economic importance of investment in effective primary and secondary prevention activities in these region (such as HPV vaccination, cervical screening programmes and Helicobacter pylori screening and treatment).…”

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

“…As a consequence, as also suggested by the Working Group of the WHO IARC and considering the easy availability of noninvasive tests, it might be recommended that countries evaluate the possibility of introducing population-based H. pylori screening and treatment programs on the basis of a correct evaluation of local factors such as the disease burden and cost-effectiveness analysis [2]. Population H. pylori screening and treatment strategies may therefore become cost-effective, at least in selected populations [35][36][37][38].…”

Helicobacter pylori Update: Gastric Cancer, Reliable Therapy, and Possible Benefits

“…As such, there is a point in the progression of the disease when a significant risk of cancer development remains despite H pylori eradication. It is at this point that secondary prevention (eg, endoscopic surveillance) programs may become cost-effective in reducing gastric cancer deaths 15, 17, 18 . Candidates who might be suitable for non-invasive, secondary prevention surveillance programs can be identified based on serum levels of pepsinogen, which can be used to determine their risk for gastric cancer (Figure 1).…”