METHODS: A state transition model for a hypothetical cohort of 15-year-olds from a healthcare payer perspective on a lifetime horizon was developed. Nine ages for H. pylori testing were considered: 15, 18, 20, 30, 40, 50, 60, 70, and 80 years. H. pylori screening was compared with no screening and annual, biennial, and triennial endoscopies starting at age 50. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios, GC cases, stage I GC cases, and GC-related deaths. One-way, two-way, and probabilistic sensitivity analyses were performed to assess the uncertainty of the parameters.
RESULTS: All H. pylori screenings at ages 15-80 were more cost-effective than all endoscopies and no screening. H. pylori screening at age 15 yielded the greatest cost-saving and benefits. The cost-effectiveness was sensitive to the adherence rate of H. pylori screening at age 15. Cost-effectiveness acceptability curves showed that H. pylori screening at age 15 was 99.6% cost-effective at a willingness-to-pay threshold of US$50,000 per QALY gained. Compared with no screening and biennial endoscopy in 15.6 million 15-year-olds from 2022 to 2037, respectively, H. pylori screening at age 15 saves US$9.70 million and US$2.39 billion, increases 1.26 million QALYs with 1312 LYs and 651 LYs, prevents 436 GC cases with 254 stage I GC cases and 305 stage I GC cases, and avoids 176 GC-related deaths and 72 GC-related deaths.
CONCLUSIONS: The optimal age for population-based H. pylori screening at ages 15-80 is the youngest, 15 years old. Shifting population-based H. pylori screening to younger people will reduce GC morbidity and mortality worldwide, along with a detailed investigation of the feasibility and long-term consequences of H. pylori eradication at a young age.
方法:从医疗保健支付者的角度出发,建立了一个假设的15岁人群的状态过渡模型。幽门螺杆菌测试的9个年龄被考虑:15、18、20、30、40、50、60、70和80岁。幽门螺杆菌筛查与无筛查和年度筛查相比,两年一次,从50岁开始进行三年一次的内窥镜检查。主要结果是成本,质量调整寿命年(QALYs),预期寿命寿命年(LYs),增量成本效益比,GC案例,第一阶段GC病例,和GC相关的死亡。单向,双向,并进行了概率敏感性分析以评估参数的不确定性。
结果:所有15-80岁的幽门螺杆菌筛查比所有内窥镜检查和无筛查更具成本效益。15岁时的幽门螺杆菌筛查产生了最大的成本节约和收益。成本效益对15岁时幽门螺杆菌筛查的依从性敏感。成本效益可接受性曲线表明,在15岁时进行幽门螺杆菌筛查的成本效益为99.6%,每个QALY的支付意愿阈值为50,000美元。与2022年至2037年分别在1560万15岁的年轻人中没有进行筛查和两年一次的内窥镜检查相比,15岁时进行幽门螺杆菌筛查可节省970万美元和23.9亿美元,增加126万个QALYs,1312个LYs和651个LYs,预防436例GC病例,其中254例I期GC病例和305例I期GC病例,避免了176例GC相关死亡和72例GC相关死亡。
结论:15-80岁人群幽门螺杆菌筛查的最佳年龄是最年轻的,15岁。将基于人群的幽门螺杆菌筛查转移到年轻人将降低全球GC发病率和死亡率,以及对年轻时根除幽门螺杆菌的可行性和长期后果的详细调查。