Objectives: Refugees and immigrants from developing countries settling in industrialised countries have a high prevalence of Helicobacter pylori (H. pylori). Screening these groups for H. pylori and use of eradication therapy to reduce the future burden of gastric cancer and peptic ulcer disease is not currently recommended in most countries. We investigated whether a screening and eradication approach would be cost effective in high prevalence populations.Methods: Nine different screening and follow-up strategies for asymptomatic immigrants from high H. pylori prevalence areas were compared with the current approach of no screening. Cost effectiveness comparisons assumed population prevalence's of H. pylori of 25%, 50% or 75%. The main outcome measure was the net cost for each cancer prevented for each strategy. Total costs of each strategy and net costs including savings from reductions in ulcers and gastric cancer were also calculated.Results: Stool antigen testing with repeat testing after treatment was the most cost effective approach relative to others, for each prevalence value. The net cost per cancer prevented with this strategy was US 111,800 (assuming 75% prevalence), 132,300 (50%) and 193,900 (25%). A test and treat strategy using stool antigen remained relatively cost effective, even when the prevalence was 25%.Conclusions: H. pylori screening and eradication can be an effective strategy for reducing rates of gastric cancer and peptic ulcers in high prevalence populations and our data suggest that use of stool antigen testing is the most cost effective approach. © 2014 Schulz et al.

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Antigens, Bacterial bacterial antigen immigrant refugee Cost benefit analysis Australia mass screening economics developing country complication follow up human Developing Countries Refugees Peptic Ulcer feces analysis controlled study cancer prevention screening test Stomach Neoplasms gastroscopy health care cost Humans migrant breath analysis male Emigrants and Immigrants stomach biopsy female Helicobacter infection cost of illness asymptomatic infection serodiagnosis antigen detection immunology isolation and purification prevalence Article sensitivity and specificity Incidence major clinical study Helicobacter Infections Feces cost control Helicobacter pylori microbiology Models, Statistical statistical model cost-benefit analysis stomach cancer cost effectiveness analysis