Abstract：
BACKGROUND: Helicobacter pylori screening with eradication reduces gastric cancer (GC) development. However, it was unknown at what age the H. pylori screening should be implemented to achieve the greatest benefits at the least cost. This study aimed to determine the optimal age of H. pylori screening for primary GC prevention.
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.
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.
摘要：
背景：根除幽门螺杆菌筛查可减少胃癌（GC）的发生。然而,尚不清楚应在什么年龄实施幽门螺杆菌筛查,以便以最小的成本获得最大的益处.本研究旨在确定幽门螺杆菌筛查初级GC预防的最佳年龄。
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。
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。
