YI-CHIA LEELin J.-T.Wu H.-M.Liu T.-Y.Yen M.-F.HAN-MO CHIUHSIU-PO WANGMING-SHIANG WUChen, Tony Hsiu HsiTony Hsiu HsiChen2021-01-152021-01-1520071055-9965https://www.scopus.com/inward/record.uri?eid=2-s2.0-34250365667&doi=10.1158%2f1055-9965.EPI-06-0758&partnerID=40&md5=e5275057a0308d069e822a9c72550e2ahttps://scholars.lib.ntu.edu.tw/handle/123456789/541130Objective: The present study is done to assess the relative cost-effectiveness, optimal initial age, and interscreening interval between primary and secondary prevention strategies for gastric cancer. Methods: Base-case estimates, including variables of natural history, efficacy of intervention, and relevant cost, were derived from two preventive programs targeting a high-risk population. Cost-effectiveness was compared between chemoprevention with 13C urea breath testing followed by Helicobacter pylori (H. pylori) eradication and high-risk surveillance based on serum pepsinogen measurement and confirmed by endoscopy. The main outcome measure was cost per life-year gained with a 3% annual discount rate. Results: The incremental cost-effectiveness ratio (ICER) for once-only chemoprevention at age 30 years versus no screening was U.S. $17,044 per life-year gained. Eradication of H. pylori at later age or with a periodic scheme yielded a less favorable result. Annual high-risk screening at age of 50 years versus no screening resulted in an ICER of U.S. $29,741 per life-year gained. The ICERs of surveillance did not substantially vary with different initial ages or interscreening intervals. Chemoprevention could be dominated by high-risk surveillance when the initial age was older than 44 years. Otherwise, chemoprevention was more cost-effective than high-risk surveillance, either at ceiling ratios of U.S. $15,762 or up to U.S. $50,000. The relative cost-effectiveness was most sensitive to the infection rate of H. pylori and proportion of early gastric cancer in all detectable cases. Conclusions: Early H. pylori eradication once in lifetime seems more cost-effective than surveillance strategy. However, the choice is still subject to the risk of infection, detectability of early gastric cancer, and timing of intervention. Copyright ? 2007 American Association for Cancer Research.[SDGs]SDG3amoxicillin; clarithromycin; esomeprazole; adult; aged; article; atrophic gastritis; cancer prevention; cancer registry; cancer screening; cancer survival; controlled study; cost effectiveness analysis; endoscopy; health care cost; health promotion; Helicobacter infection; Helicobacter pylori; high risk population; human; outcome assessment; primary prevention; priority journal; prognosis; secondary prevention; stomach cancer; treatment outcome; urea breath test; Adult; Aged; Algorithms; Breath Tests; Chemoprevention; Computer Simulation; Cost-Benefit Analysis; Female; Helicobacter Infections; Helicobacter pylori; Humans; Male; Markov Chains; Mass Screening; Middle Aged; Primary Prevention; Stomach Neoplasms; Taiwanjournal article10.1158/1055-9965.EPI-06-0758175076092-s2.0-34250365667