筛查幽门螺杆菌感染预防胃癌的费用效果分析

目的评价在人群中筛选幽门螺杆菌感染以预防胃癌的临床和经济学效果.方法用Markov模型估计在10万名40岁～45岁人群中筛查幽门螺杆菌感染者并对筛查试验阳性者进行治疗的远期效果及费用,并与不进行任何干预的结果相比较,进行卫生经济学评价.对治疗感染者减少胃癌发生危险度的有效率和胃癌发病率进行敏感性分析.结果在有效率为50%时,每筛查10万人可减少291例胃癌的发生,增加2612个生命年.当预防胃癌的有效率从5%到100%变化时,每增加一个生命年的费用从7747元下降到2325元,在胃癌高发区筛查更经济有效.结论筛查幽门螺杆菌感染是一种潜在的能减少胃癌发生的有效措施.

Cost-effectiveness of population based Helicobacter pylori screening to prevent gastric cancer

AIM To compare clinical and economic effects of screening for Helicobacter pylori (Hp) infection to prevent gastric cancer.METHODS A decision analysis incorporating Markov simulation model was used to screen for Hp and compare those with a positive test, and those without screen and treatment. The risk and costs were estimated by review of published reports. The sensitivity analysis for the efficacy of Hp therapy in cancer prevention as well as incidence of gastric cancer and prevalence of Hp infection was performed.RESULTS When compared with no screening, assuming the efficacy for reduction gastric cancer by Hp eradication is 50%, 291 gastric cancer would be prevented and 2612 life years would be saved per 100 000 screened. The sensitivity analysis showed the cost of per life year saved was reduced with increase of efficacy and the incidence of gastric cancer.CONCLUSION Population based H. pylori screening has the potential to produce important health benefits at a reasonable cost and efficacy of risk reduction of gastric cancer.