While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .
Helicobacter pylori and gastric cancer: what are the benefits of screening only for the CagA phenotype of H. pylori?
BACKGROUND Strains of Helicobacter pylori that express the CagA protein are associated with a threefold increased gastric cancer risk as compared to H. pylori strains that do not express CagA. Screening and treatment only for CagA antibodies should target those individuals at highest gastric cancer risk while reducing the number of patients requiring antibiotics . We compared the costs and benefits of screening asymptomatic 50-year-old individuals for CagA , screening for all H. pylori strains , and no screening , both in the United States and abroad . MATERIAL S AND METHODS We employed Markov cost-effectiveness analysis using data from r and omized , case-control , and cohort studies . RESULTS In the United States , CagA screening would result in 1.5 million fewer antibiotic treatments but would prevent 1,400 fewer gastric cancers than would screening for all H. pylori . The incremental cost-effectiveness of CagA screening is $ 23,900 per life-year gained ; for H. pylori screening , it is $ 25,100 . Screening in countries with epidemiological characteristics similar to those of Colombia , Finl and , and Japan costs less than $ 5,000 per life-year gained , and the difference between CagA and H. pylori screening is smaller than that in the United States . CONCLUSIONS Screening only for CagA-positive H. pylori is not substantially better than is screening for all H. pylori , either in the United States nor abroad . Screening is substantially more cost-effective outside the United States . Whether population screening is justified , however , is uncertain pending conclusive data regarding the reduction in gastric cancer risk from antibiotics
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
Use and acceptance of health economic evaluations ( HEEs ) has been much greater in developed than in developing nations .
Nevertheless , while developing countries lag behind in the development of HEE methods , they could benefit from the progress made in other countries and concentrate on ways in which existing methods can be used or would need to be modified to fulfill their specific needs .
HEEs , as context -specific tools , are not easily generalizable from setting to setting .
Existing studies regarding generalizability and transferability of HEEs have primarily been conducted in developed countries .
Therefore , a legitimate question for policy makers in Latin America and the Caribbean region ( LAC ) is to what extent HEEs conducted in industrialized economies and in LAC are generalizable to LAC ( trans-regional ) and to other LAC countries ( intra-regional ) , respectively .