The cost effectiveness of Helicobacter pylori population screening—economic evaluation alongside a randomised controlled trial with 13‐year follow‐up

• Published in: Alimentary pharmacology & therapeutics 2019-04, Vol.49 (8), p.1013-1025
• Main Authors: Høgh, Maria Bomme, Kronborg, Christian, Hansen, Jane Møller, Schaffalitzky de Muckadell, Ove B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Breath Tests; Cost effectiveness; Cost-Benefit Analysis; Female; Follow-Up Studies; Gastric cancer; Health risks; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Helicobacter pylori - isolation & purification; Humans; Male; Mass Screening - methods; Middle Aged; Peptic Ulcer - prevention & control; Peptic ulcers; Population; Quality of Life; Quality-Adjusted Life Years; Randomization; Stomach Neoplasms - prevention & control; Surveys and Questionnaires; Treatment Outcome; Urea; Urea - metabolism
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.15193

Summary Background Helicobacter pylori eradication improves dyspeptic symptoms in 8%‐10%, prevents peptic ulcer and may reduce the risk of gastric cancer. Availability of a high quality diagnostic test and an effective treatment makes population screening and eradication of Helicobacter pylori an attractive option. Aim To evaluate the cost effectiveness of Helicobacter pylori population screening and eradication. Methods Cost effectiveness analysis and cost utility analysis alongside randomised controlled trial with 13 years follow‐up. The evaluation has a societal perspective. A random general population sample of 20 011 individuals aged 40‐65 were randomised and invited in 1998‐1999; 12 530 were enrolled and, of these, 8658 have been successfully followed up at 1, 5, and 13 years after intervention. Questionnaires included the quality of life instrument SF‐36. From SF‐36 responses an SF‐6D score was derived and used for calculation of quality‐adjusted life years. Register data on costs, use of health care resources and medication were obtained for all randomised individuals. The intervention was an invitation to Helicobacter pylori screening by in‐office blood test; positive tests were validated by 13C‐urea breath test. Those who tested positive were offered eradication therapy. Main outcome measures were Incremental cost per quality‐adjusted life year and life‐years gained. Results Helicobacter pylori population screening and eradication with 13 years follow‐up was not effective in regards to quality of life and the cost per screened person was higher than not screening (mean difference 11 269 DKK [95% CI: 3175‐19 362]). The probability of being cost‐effective was 80% at a threshold of 400 000 DKK (approximately 53,800 Euros) of willingness‐to‐pay per life‐year gained. Conclusions Helicobacter pylori population screening and eradication with 13 years follow‐up was not effective in regards to quality of life and the cost of screening was higher than not screening.