Date of Award

January 2024

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Shi-yi Wang

Second Advisor

A. David Paltiel

Abstract

Background: Gastric cancer remains a significant public health concern, particularly for Asian Americans in the United States, who are at higher risk. Helicobacter pylori (H. pylori) infection is a known risk factor for gastric cancer (GC) and peptic ulcer disease (PUD), and its eradication has proven effective in preventing both conditions. Due to the lack of clinical standards in H. pylori screening for this high-risk group of Asian Americans, we explore whether population-based screening using carbon-13 urea breath test (C-UBT) and/or endoscopy is cost-effective in the United States for Asian Americans. Methods: We built a cohort state-transition Markov model to compare three strategies: 1) no screening or opportunistic eradication of H. pylori, 2) a one-time, population-based C-UBT screening and eradication for H. pylori, and 3) a one-time, population-based upper endoscopy with biopsies and eradication for H. pylori. We use Incremental Cost-Effectiveness Ratios (ICERs) to compare the alternatives, with a Willingness-To-Pay (WTP) threshold of $100,000 per Quality-adjusted Life Year (QALY). Both one-way and probabilistic sensitivity analyses (PSA) were performed to account for uncertainty. Results: The no-screening strategy is a dominated; both C-UBT and endoscopy are cost-saving and result in higher QALYs than no screening. Endoscopy screening is cost-effective, and the ICER for endoscopy is $3190.02 per QALY gained compared to C-UBT screening. Additionally, both screenings reduce the lifetime risk of GC from 11.52% to 0.022% and 0.023%, and the lifetime risk of PUD from 0.82% to 0.236% and 0.252% for endoscopy and C-UBT, respectively. Conclusions: This analysis concludes that endoscopic screening and eradicating H. pylori infection is a cost-effective strategy in the prevention of gastric cancer and peptic ulcer disease for Asian Americans in the United States.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/07/2026

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