Screening and Treating H. Pylori in Those at High Risk for Gastric Cancer Appears Cost-Effective

By Reuters Staff

September 14, 2021

NEW YORK (Reuters Health) - Screening for and treating Helicobacter pylori infection in those at high risk for gastric cancer is cost effective, a new modeling study shows.

"This modeling study suggests that even after accounting for costs of treatment, the strategy is beneficial and results in substantial decrease in cancer incidence," Dr. Chin Hur of Columbia University in New York and colleagues note in Gastroenterology.

They found that the two noninvasive screening strategies they tested - 13C-Urea Breath Test (UBT) and stool antigen test - had "very similar" results in terms of costs and quality-adjusted life-years (QALYs).

The research team used a Markov model to determine whether people with a family history of gastric cancer benefit from H. pylori testing and treatment compared to not testing.

The hypothetical cohort was made up of 40-year-old men and women in the U.S. with a first-degree relative with gastric cancer.

Individuals with H. pylori infection were treated with a seven-day triple therapy regimen, followed by a 14-day quadruple drug regimen in cases of failed eradication.

The model adopted a willingness to pay (WTP) threshold of $100,000/QALY to determine whether a strategy was cost-effective.

The base-case analysis found that screening is cost-effective compared to not screening and both screening strategies were less costly and led to greater QALYs than not screening.

The costs of not screening were $2,694 and resulted in 21.95 QALYs, while screening with UBT cost $2,105 and yielded 22.37 QALYs. Screening with stool antigen was comparable to UBT, with costs of $2,126 and 22.30 QALYs.

All screening strategies led to a decrease in incidence of and death from gastric cancer.

With no screening, roughly 2.04% of patients developed gastric cancer and 1.82% died of the disease. In contrast, with screening, cancer incidence fell to 1.59% to 1.65% and deaths fell to 1.41% to 1.46%, depending on the screening strategy, representing a 19.1% to 22.0% reduction in risk.

Both noninvasive screening strategies were cost-effective compared with not screening at all WTP thresholds.

The researchers note that while recent studies and commentaries have called for gastric-cancer screening for certain groups, the role of testing for H. pylori specifically among individuals with a family history of gastric cancer in the U.S. has yet to be explored.

"Our study suggests it may be worthwhile in this group," they conclude.

The study had no commercial funding and the authors have no relevant disclosures.

SOURCE: Gastroenterology, online August 27, 2021.