OBJECTIVES:

High prevalence of Helicobacter pylori (H. pylori) is a troublesome public health issue in China. Studies have proved that screening and eradication of H. pylori can reduce the prevalence of gastric cancer effectively. However, whether large scale of screening and eradicating H. pylori should be performed in China among asymptomatic ones is still controversial. The aim of this study was to determine the most cost-effective strategy to screen H. pylori in China.

METHODS:

Using a Markov model, we examined the cost-effectiveness of three screen-and-treat strategies by varying starting age at 20, 30, and 40, respectively, compared with no-screening strategy. We simulated 1,000,000 individuals for each scenario. The main outcomes included gastric cancer incidence reduction, number of cause-specific deaths, costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses were done to explore the robustness of model findings.

RESULTS:

Compared with no screening, strategies of screening at 20, 30, and 40 years of age were all cost-effective, with ICERs of ￥-87.15, ￥470.37 and￥2439.10 per QALY respectively. Screening at 20 years was highly cost-effective, compared with other screening strategies. Each screen strategy prevented 19,000, 14,030 and 10,135 gastric cancer cases. Uncertainty of screening age from 20 to 40 did not affect the cost-effectiveness of the screen-and-treat strategy over the no-screen strategy. The deterministic and probabilistic sensitivity analyses confirmed the robustness of the study results.

CONCLUSIONS:

Compared with the other strategies, screen-and-treat strategy at age of 20 years for H. pylori infection was less costly and more effective for preventing gastric cancer in Chinese asymptomatic population with H. pylori.