BACKGROUND & AIMS:
Population screening and treatment of Helicobacter pylori has been advocated
as a means of reducing mortality from gastric cancer, as well as dyspepsia
and dyspepsia-related resource use. Previous programs have failed to
demonstrate a significant effect on mortality or resource use, but follow-up
was only for 1 or 2 years. We aimed to determine the effect of screening for
H pylori on dyspepsia and dyspepsia-related resource use over 10 years.
METHODS:
H pylori-positive individuals, aged 40-49 years, enrolled in a community
screening program, randomized to eradication therapy or placebo in 1994,
were sent a validated dyspepsia questionnaire by mail 10 years later, and
primary care records were reexamined. Consultation, referral, prescribing,
and investigation data related to dyspepsia were extracted. United Kingdom
costs were applied to derive total cost per person (1 pound = 1.8 dollars).
RESULTS:
Of 2324 original participants, 1864 (80%) were traced and contacted. Of
these, 1086 (47%) responded, and 919 (40%) agreed to a review of their
primary care records. There was a 10-year mean saving in total
dyspepsia-related costs of 117 dollars per person (95% confidence interval
[CI] = 11 dollars-220 dollars, P = .03) with eradication therapy. Those
symptomatic at baseline showed a nonsignificant trend toward resolution of
symptoms at 10 years with eradication therapy (relative risk of remaining
symptomatic, 0.89; 95% CI: 0.77-1.03).
CONCLUSIONS:
There were significant reductions in total dyspepsia-related health care
costs. The savings made were greater than the initial cost of H pylori
screening and treatment.
Reference:
Gastroenterology. 2005 Dec;129(6):1910-7 |