Family‐based Helicobacter pylori infection control and management strategy and screen‐and‐treat strategy are highly cost‐effective in preventing multiple upper gastrointestinal diseases in Chinese population at national level

Abstract

AbstractBackgroundThe overall benefits of the newly introduced family‐based Helicobacter pylori (H. pylori) infection control and management (FBCM) and screen‐and‐treat strategies in preventing multiple upper gastrointestinal diseases at national level in China have not been explored. We investigate the cost‐effectiveness of these strategies in the whole Chinese population.Materials and MethodsDecision trees and Markov models of H. pylori infection‐related non‐ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC) were developed to simulate the cost‐effectiveness of these strategies in the whole 494 million households in China. The main outcomes include cost‐effectiveness, life years (LY), quality‐adjusted life year (QALY), and incremental cost‐effectiveness ratio (ICER).ResultsWhen compared with no‐screen strategy, both FBCM and screen‐and‐treat strategies reduced the number of new cases of NUD, PUD, PUD‐related deaths, and the prevalence of GC, and cancer‐related deaths. The costs saved by these two strategies were $1467 million and $879 million, quality‐adjusted life years gained were 227 million and 267 million, and life years gained were 59 million and 69 million, respectively. Cost‐effectiveness analysis showed that FBCM strategy costs −$6.46/QALY and −$24.75/LY, and screen‐and‐treat strategy costs −$3.3/QALY and −$12.71/LY when compared with no‐screen strategy. Compared to the FBCM strategy, the screen‐and‐treat strategy reduced the incidence of H. pylori‐related diseases, added 40 million QALYs, and saved 10 million LYs, but at the increased cost of $588 million. Cost‐effectiveness analysis showed that screen‐and‐treat strategy costs $14.88/QALY and $59.5/LY when compared with FBCM strategy. The robustness of the results was also verified.ConclusionsBoth FBCM and screen‐and‐treat strategies are highly cost‐effective in preventing NUD, PUD, and GC than the no‐screen strategy in Chinese families at national level. As FBCM strategy is more practical and efficient, it is expected to play a more important role in preventing familial H. pylori infection and also serves as an excellent reference for other highly infected societies.