{
  "abstract": "Background Population-based Helicobacter pylori (H.pylori) eradication reduces gastric cancer (GC) risk, yet evidence on its cost-effectiveness is still needed. We conducted an economic evaluation of H.pylori screen-and-treat strategy for GC prevention alongside a large-scale, cluster-randomized, controlled trial.Methods A within-trial economic evaluation was performed from the healthcare system perspective based on the Mass Intervention Trial in Linqu, Shandong Province, China (n=180,284, 2011-2022). H.pylori-positive individuals were randomized to receive anti-H.pylori treatment or symptom alleviation treatment. We examined the incremental mean cost per participant and incremental effect on GC prevention for the cost-effectiveness analysis, and the incremental quality-adjusted life-years (QALYs) and incremental net monetary benefit (INMB) for the cost-utility analysis. Non-parametric bootstrap was used to examine the uncertainty with 5000 replications.Results During 11.8 years’ follow-up, the mean cost per participant was reduced by $11.55 (95% confidence interval (CI): -$4.14, $25.08) for anti- H.pylori treatment, and by $16.89 (95%CI: $3.82, $28.34) for successful eradication, compared with that for symptom alleviation treatment. Anti-H.pylori treatment yielded an estimated reduction of 53.37 (95%CI: 0.18, 99.47) GC cases, and averted 0.0016 QALY loss (95%CI: 0.0001, 0.0031) per participant (INMB= $20.39, 95%CI: $3.68, $37.10). Successful eradication was particularly cost-saving with an estimated reduction of 75.81 (95%CI: 15.96, 123.69) GC cases, and an average gain of 0.0021 QALY (95%CI: 0.0002, 0.0039) per participant (INMB=$28.08, 95%CI: $12.33, $43.83). Besides, H. pylori treatment did not change incremental mean cost, incremental effect or QALYs when other cancers were considered as outcomes (INMB=-$17.90, 95%CI: -$58.63, $22.83). Bootstrapped pairs of costs and QALYs showed that the probability of being cost-saving was 91.88% (4594/5000 replications), and the probability of being cost-effective was 96.48% (4824/5000 replications) for H.pylori-positive individuals receiving anti-H.pylori treatment. Furthermore, H.pylori treatment demonstrated significant cost savings (INMB=$20.86, 95%CI: $7.19, $34.52) for individuals <45 years. Economic benefits remained even when considering trial participants in the screen-and-treat scenario without using symptom alleviation treatment and conducting repeat H. pylori infection test post-treatment, and providing full insurance coverage for H.pylori treatment for individuals aged <45 years.Conclusions Community-based H.pylori screening and treatment was cost-effective for GC prevention and improvement of QALY based on a large-scale intervention trial.",
  "authors": [
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Zhi-Qiang Hu"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Lian Zhang"
    },
    {
      "affiliations": [
        "Health Bureau of Linqu County, Weifang, China"
      ],
      "name": "Wei-Dong Liu"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Jun-Ling Ma"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Yang Zhang"
    },
    {
      "affiliations": [
        "Department of Medical Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany"
      ],
      "name": "Kurt Ulm"
    },
    {
      "affiliations": [
        "Health Bureau of Linqu County, Weifang, China"
      ],
      "name": "Jian-Xi Wang"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Lei Zhang"
    },
    {
      "affiliations": [
        "Health Bureau of Linqu County, Weifang, China"
      ],
      "name": "Lan-Fu Zhang"
    },
    {
      "affiliations": [
        "Health Bureau of Linqu County, Weifang, China"
      ],
      "name": "Ming Li"
    },
    {
      "affiliations": [
        "Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany"
      ],
      "name": "Michael Vieth"
    },
    {
      "affiliations": [
        "Freiburg: Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Freiburg, Germany",
        "School of Medicine and Health, Technical University of Munich, Germany"
      ],
      "name": "Michael Quante"
    },
    {
      "affiliations": [
        "Health Bureau of Linqu County, Weifang, China"
      ],
      "name": "Le-Hua Wang"
    },
    {
      "affiliations": [
        "Department of Medicine & Department of Gastrointestinal Oncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic"
      ],
      "name": "Stepan Suchanek"
    },
    {
      "affiliations": [
        "Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Department Preclinical Medicine, Technical University of Munich, Germany"
      ],
      "name": "Raquel Mejias-Luque"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Xuan Han"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Heng-Min Xu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Xiao-Han Fan"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Zong-Chao Liu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Wen-Jing Zhao"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Xin-Ling Wang"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Xiao-Ping Qiu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Xi-Ruo Pang"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Tong Zhou"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Wei-Xiang Guan"
    },
    {
      "affiliations": [
        "Department of Medicine II, TUM School of Medicine, Klinikum rechts der Isar, Technical University Munich, Germany"
      ],
      "name": "Roland M Schmid"
    },
    {
      "affiliations": [
        "Institute for Medical Microbiology, Immunology and Hygiene, TUM School of Medicine and Health, Department Preclinical Medicine, Technical University of Munich, Germany"
      ],
      "name": "Markus Gerhard"
    },
    {
      "affiliations": [
        "Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing, China"
      ],
      "name": "Wei-Cheng You"
    },
    {
      "affiliations": [
        "Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"
      ],
      "name": "Zi-Ting Wu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Kai-Feng Pan"
    },
    {
      "affiliations": [
        "State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, 52 Fu-cheng Road, Haidian District, Beijing, China"
      ],
      "name": "Wen-Qing Li"
    }
  ],
  "title": "IDDF2026-ABS-0416 Cost-effectiveness of community eradication of helicobacter pylori for gastric cancer prevention: an economic evaluation alongside a cluster-randomized controlled trial",
  "uid": "17f15f67-a8fe-5322-81ba-145a48b95ae3"
}