Cost-Effectiveness Analysis of Population Screening and Treatment of Helicobacter pylori in the Setting of Antibiotic Resistance in Mexico
Published in 40th Annual North American Meeting of the Society for Medical Decision Making, 2018
Abstract
Purpose
Gastric cancer is the third cause of cancer death in Mexico. Helicobacter pylori (H. pylori) is the strongest known biological risk factor for gastric cancer (a six-fold increase of risk compared to H. pylori negative individuals). Antibiotic treatment for H. pylori reduces the risk of gastric cancer but induces antibiotic resistance (ABR). We estimated the cost-effectiveness of various screen-and-treat strategies for H. pylori infection accounting for ABR in Mexico.
Methods
We developed an age-structured mathematical model to simulate the dynamics of H. pylori infection, ABR and gastric cancer of the Mexican population. We explicitly modeled the progression of underlying gastric carcinogenesis including gastritis, intestinal metaplasia, dysplasia and ultimately non-cardia gastric cancer (NCGC). We calibrated the parameters governing the natural history of gastric disease to observed epidemiological data from Mexico, such as age-specific prevalence of gastric lesions and gastric cancer incidence, using a Bayesian approach. We estimated the cost-effectiveness of two different annual screen-and-treat policies in different age groups: (1) test only for H. pylori infection and treat if positive (SnT), and (2) test for H. pylori infection and if positive, test for susceptibility and if test indicates susceptibility to clarithromycin, treat with clarithromycin; otherwise, treat with second line treatment (SnT-ST). We assumed policies are implemented in 2018 and are carried out over 13 years
Results
All screening policies produced higher effectiveness at a higher cost compared to a no-screen-and-no-treat policy (Policy 1). Policies including susceptibility test were more effective but also costed more than their counterparts without susceptibility test. In the case of SnT-ST 2-6-year-olds (Policy 5) and SnT-ST all (Policy 7), the additional benefits obtained with susceptibility test outweighed the additional costs of the test (see Figure). Using a cost-effectiveness threshold in Mexico of one GDP per capita (MXN$132,000) per quality-adjusted life years (QALYs) gained, screening and treating the entire population with a susceptibility test (Policy 7) would be cost-effective from the health care payer’s perspective with an incremental cost-effectiveness ratio of MXN$7,796/QALY.
Conclusions
H. pylori screen-and-treat with susceptibility test the entire population can substantially improve quality of life and be cost-effective in the Mexican setting.