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