Abstract：
BACKGROUND: The 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.
METHODS: Decision 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).
RESULTS: When 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.
CONCLUSIONS: Both 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.
METHODS: Decision 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).
RESULTS: When 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.
CONCLUSIONS: Both 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.
摘要：
背景：新引入的基于家族的幽门螺杆菌的总体益处（H。pylori）感染控制和管理（FBCM）以及在中国国家一级预防多种上消化道疾病的筛查和治疗策略尚未得到探索。我们调查了这些策略在整个中国人口中的成本效益。
方法：幽门螺杆菌感染相关非溃疡性消化不良（NUD）的决策树和马尔可夫模型，消化性溃疡病（PUD），和胃癌（GC）被开发来模拟这些策略在中国整个4.94亿家庭中的成本效益。主要成果包括成本效益，生命年（LY），质量调整寿命年(QALY)，和增量成本效益比(ICER)。
结果：与无屏幕策略相比，FBCM和筛查和治疗策略都减少了NUD的新病例数，PUD,PUD相关死亡,以及GC的患病率，和癌症相关的死亡。这两种策略节省的成本分别为1.467亿美元和8.79亿美元,获得的质量调整生命年分别为2.27亿和2.67亿，获得的生命年分别是5900万和6900万，分别。成本效益分析表明，FBCM战略成本-6.46美元/季度和-24.75美元/季度，与无屏幕策略相比，屏幕和治疗策略成本-3.3美元/QALY和-12.71美元/LY。与FBCM战略相比，筛查和治疗策略降低了幽门螺杆菌相关疾病的发病率，增加了4000万个QALY，拯救了1000万LYS,但增加了5.88亿美元的成本。成本效益分析表明，与FBCM策略相比，筛查和治疗策略的成本为14.88美元/QALY和59.5美元/LY。结果的鲁棒性也得到了验证。
结论：FBCM和筛查和治疗策略在预防NUD方面都具有很高的成本效益，PUD,和GC比中国家庭在国家层面的无屏幕战略。随着FBCM战略更加实用和高效，预计它将在预防家族性幽门螺杆菌感染中发挥更重要的作用，也是其他高度感染社会的极好参考。
方法：幽门螺杆菌感染相关非溃疡性消化不良（NUD）的决策树和马尔可夫模型，消化性溃疡病（PUD），和胃癌（GC）被开发来模拟这些策略在中国整个4.94亿家庭中的成本效益。主要成果包括成本效益，生命年（LY），质量调整寿命年(QALY)，和增量成本效益比(ICER)。
结果：与无屏幕策略相比，FBCM和筛查和治疗策略都减少了NUD的新病例数，PUD,PUD相关死亡,以及GC的患病率，和癌症相关的死亡。这两种策略节省的成本分别为1.467亿美元和8.79亿美元,获得的质量调整生命年分别为2.27亿和2.67亿，获得的生命年分别是5900万和6900万，分别。成本效益分析表明，FBCM战略成本-6.46美元/季度和-24.75美元/季度，与无屏幕策略相比，屏幕和治疗策略成本-3.3美元/QALY和-12.71美元/LY。与FBCM战略相比，筛查和治疗策略降低了幽门螺杆菌相关疾病的发病率，增加了4000万个QALY，拯救了1000万LYS,但增加了5.88亿美元的成本。成本效益分析表明，与FBCM策略相比，筛查和治疗策略的成本为14.88美元/QALY和59.5美元/LY。结果的鲁棒性也得到了验证。
结论：FBCM和筛查和治疗策略在预防NUD方面都具有很高的成本效益，PUD,和GC比中国家庭在国家层面的无屏幕战略。随着FBCM战略更加实用和高效，预计它将在预防家族性幽门螺杆菌感染中发挥更重要的作用，也是其他高度感染社会的极好参考。
