Projected country-level health effects and service requirements of Helicobacter pylori screen-and-treat and targeted endoscopic screening, 2025–2050: a comparative modelling study

Helicobacter pylori eradication reduces gastric cancer incidence. We compared improvements in testing, treatment and endoscopic screening to identify their projected health gains and service requirements. We combined Global Burden of Disease 2023 estimates, population projections and country infection and service inputs in an annual age and sex cohort model for 204 locations during 2025–2050. Improvements were compared with assigned future country programmes. Endoscopy expansion was evaluated in 11 locations with empirical capacity inputs. We estimated uncertainty in 1000 joint simulations and compared predictions with published trial outcomes. Expanded delivery was projected to avert 626,518 additional cases, 424,272 deaths (95% uncertainty interval 17,584–939,068) and 10.82 million disability-adjusted life years, requiring 2.96 billion additional initial tests. The mortality reduction was 1.49% of reference deaths. Separate 10-percentage-point increases in testing access and participation averted 87,082 and 82,582 additional deaths. First-line eradication success of at least 90% reduced antibiotic use by 91.02 million courses. Completing at least 80% of scheduled endoscopies in the 11 eligible locations averted 756,786 additional deaths and required 2.35 billion additional examinations. Long-term prevention was underestimated in Shandong, and external mortality comparisons remained imprecise. Expanding testing and improving treatment after a positive result offer distinct routes to greater prevention. Higher first-line eradication success reduces repeat treatment in the model. The country comparisons link these improvements to service workload and support local planning, with cancer gains dependent on delivery and effect assumptions.