Cost-effectiveness of adding a <i>Helicobacter pylori</i> antibody test to the upper gastrointestinal series in gastric cancer screening at the workplace

Abstract

Objective: Helicobacter pylori infections increase gastric cancer risk. Detecting and eradicating Helicobacter pylori infections and implementing a follow-up strategy should be considered by occupational health practitioners. This study aimed to evaluate the cost-effectiveness of adding an H. pylori antibody (HPA) test to current gastric cancer screening using upper gastrointestinal series (UGI) at the workplace in Japan. Methods: The data of Japanese people aged ≥ 40 years were collected from PubMed and evaluated in two cohorts: UGI (X-ray examination) + HPA test and UGI only. A Markov model was used for the cost-effectiveness analysis of the UGI + HPA test and UGIonly cohorts. The main outcomes were cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The impact of uncertainty was assessed using one-way sensitivity analyses (OWSA) and probabilistic sensitivity analyses (PSA). Results: A base-case analysis showed that the UGI + HPA test strategy was less costly ( − US$1,039 and − US$1,496) and more effective (0.415 and 0.437 QALYs) than the UGI-only strategy in the 40-and 50-year-old groups, respectively. The UGI + HPA test strategy was assessed as a dominant strategy. In the OWSA, the tornado diagram showed negative expected costs and positive QALY gains within the established ranges for all parameters. In the PSA, more than 95% of the simulations demonstrated ICER < 5 million yen (US$51,674; US$1 = 96.76 yen)/QALY. Conclusions: This modeling study suggests that gastric cancer screening using UGI + HPA test followed by eradication and annual opportunistic screening, compared with UGI only, resulted in lower costs and greater QALY gains for both 40-and 50-year-old groups at the workplace.