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POPULATION-BASED AND OPPORTUNISTIC SCREENING AND ERADICATION OF HELICOBACTER PYLORI

An Analysis Using Trial Baseline Data

Published online by Cambridge University Press:  01 October 1999

James M. Mason ,
Paul Moayyedi ,
Philip J. Young ,
Sara Duffett ,
Will Crocombe ,
Michael F. Drummond  and
Anthony T. R. Axon
James M. Mason
Affiliation:
University of York
Paul Moayyedi
Affiliation:
University of Leeds
Philip J. Young
Affiliation:
University of York
Sara Duffett
Affiliation:
University of Leeds
Will Crocombe
Affiliation:
University of Leeds
Michael F. Drummond
Affiliation:
University of York
Anthony T. R. Axon
Affiliation:
General Infirmary at Leeds and University of Leeds
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Abstract

Objectives: To examine whether screening and eradication of Helicobacter pylori by population-based invitation or opportunistic screening by general practitioners reduces costs to the National Health Service (NHS) of treating dyspepsia.

Methods: A limited dependent, variable, two-step regression analysis was used to explore the baseline annual health care costs of dyspepsia for men and women aged 40–49 enrolled in the Leeds H. pylori screening and eradication trial.

Results: Epidemiological and clinical questionnaires, general practitioner notes, and 13C urea breath test results were available for 4,754 individuals. After adjusting for covariates, H. pylori was associated with a 6.7% increased probability of incurring gastrointestinal-related NHS costs (p < .0001) in the population aged 40-49. Additionally, H pylori increased average costs in those who seek medical care (p = .001). In consequence, H. pylori is associated with an average increased cost to the NHS of £0.30 per year (95% CI: £0.17 to £0.45) per adult aged 40–49. In those consulting for dyspepsia, the increased cost to the NHS was £1.04 per year (95% CI: £0.42 to £1.75) per patient. The cost of population screening and treatment would not be recovered in reduced dyspepsia costs in the lifetime of those screened. Assuming laboratory-based serology screening is used opportunistically in patients presenting with dyspepsia, it is estimated that costs would be recouped in 18 years.

Conclusions: This observational data set suggests that the costs of screening and treatment in all individuals aged 40–49 or in those presenting in primary care with dyspeptic symptoms are unlikely to be attractive on the basis of cost savings alone.

Keywords

Helicobacter pyloriEconomicsMass screening
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 15 , Issue 4 , October 1999 , pp. 649 - 660
Copyright
© 1999 Cambridge University Press

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Footnotes

The following are participants in the Leeds H. pylori Study Group. Clinical Coordinators: Prof. A. T. R. Axon, Centre for Digestive Diseases, General Infirmary at Leeds and University of Leeds; Prof. A. C. Dowell, Centre for Research in Primary Care, University of Leeds; Prof. I. D. G. Richards, Institute of Epidemiology and Health Services Research, University of Leeds; Prof. P. Heywood, Centre for Research in Primary Care, University of Leeds; and Dr. P. Moayyedi, Centre for Digestive Diseases, General Infirmary at Leeds and University of Leeds. Trial Coordinators: Dr. S. Mason, Yorkshire Clinical Trials and Research Unit, Leeds; Mr. W. Crocombe, Yorkshire Clinical Trials and Research Unit, Leeds; Ms. J. Norton, Yorkshire Clinical Trials and Research Unit, Leeds; and Ms. R. Muthukumar, Yorkshire Clinical Trials and Research Unit, Leeds. Health Economists: Dr. J. M. Mason, Centre for Health Economics, University of York; and Prof. M. F. Drummond, Centre for Health Economics, University of York. Statistical Support: Mr. D. Braunholtz, Department of Public Health and Epidemiology, University of Birmingham; Mr. R. Feltbower, Department of Pediatric Epidemiology, University of Leeds; Ms. P. McKinney, Department of Pediatric Epidemiology, University of Leeds; and Dr. P. J. Young, Department of Health Sciences, University of York. Research Nurses: Mrs. S. Duffett, Institute of Epidemiology and Health Services Research, University of Leeds; Mrs. P. Atha, Institute of Epidemiology and Health Services Research, University of Leeds; Mrs. M. Liptrott, Institute of Epidemiology and Health Services Research, University of Leeds; and Mrs. J. Nathan, Institute of Epidemiology and Health Services Research, University of Leeds. Data Monitoring Committee: Prof. D. Forman, Centre for Cancer Research, University of Leeds; Dr. R. Spiller, Department of Gastroenterology, Queens Medical Centre, Nottingham; and Ms. M. Jones, Yorkshire Clinical Trials and Research Unit, Leeds.