Population-based and opportunistic screening and eradication of Helicobacter pylori -: An analysis using trial baseline data

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 C-13 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 to (p<.0001) in the population aged 40-49. Additionally, H pylori increased average costs: in those who seek medical care to (p = .001). In consequence, H. pylori is associated with an average increased cast to the NHS of pound 0.30 per year (95% Cl: pound 0.17 to pound 0.45) per adult aged 40-49. In those consulting for dyspepsia, the increased cost to the NHS was pound 1.04 per year (95% Cl: pound 0.42 to pound 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.