Cost-effectiveness of six strategies for Helicobacter pyloridiagnosis and management in uninvestigated dyspepsia assuming a high resource intensity practice pattern

Abstract

BackgroundInitial assessment of dyspepsia often includes noninvasive testing for Helicobacter pylori infection. Commercially available tests vary widely in cost and accuracy. Although there is extensive literature on the cost-effectiveness of H. pylori treatment, there is little information comparing the cost-effectiveness of various currently used, noninvasive testing strategies.MethodsA Markov simulation was used to calculate cost per symptom-free year and cost per correct diagnosis. Uncertainty in outcomes was estimated using probabilistic sensitivity analysis.ResultsUnder the baseline assumptions, cost per symptom-free year was $122 for empiric proton pump inhibitor (PPI) trial, and costs for the noninvasive test strategies ranged from $123 (stool antigen) to $129 (IgG/IgA combined serology). Confidence intervals had significant overlap.ConclusionsUnder our assumptions for how testing for H. pylori infection is employed in United States medical practice, the available noninvasive tests all have similar cost-effectiveness between one another as well as with empiric PPI trial.

GenoType® HelicoDR test in comparison with histology and culture for Helicobacter pylori detection and identification of resistance mutations to clarithromycin and fluoroquinolones

“…In recent years, the use of a culture technique as a diagnostic tool has become less common, mainly due to difficulties arising from the cultivation process of the bacterium, particularly the time‐consuming process of classical culture (5‐7 days). Culture techniques are mostly employed after treatment failure as they provide information on the antibiotic susceptibility profile, thereby serving an important role in empiric antibiotic treatment and management of refractive cases …”

A novel one-step Helicobacter pylori saliva antigen test

“…Using noninvasive tests to screen young patients and children 4,10 who present with dyspepsia has been advocated on the basis of a decrease in overall endoscopy workload and resultant financial savings. 12 Recently, some noninvasive methods of testing for H. pylori have become available: (1) the 13 C-or 14 C-labeled UBT; (2) serology (based on detection of a specific anti-H. pylori IgG antibody in the patient's serum); and (3) H. pylori stool antigens test. Several novel methods of detecting H. pylori have recently been described and include detecting antibodies in saliva and urine and detecting antigens in stool.…”

Diagnosis of Helicobacter pylori Infection

“…The cost of the different diagnostic tests is often taken into consideration by service providers determining which tests should be made available in laboratories to local clinicians. Serology is the cheapest test but is not the most accurate [68]. Nine health economic evaluations were included in a 2009 Health Technology Assessment (HTA) report by Nocon et al.…”

“…Surprisingly, the initial choice of test (serology, SAT or UBT) did not have a significant influence on the overall cost‐effectiveness in a range of H. pylori prevalence between 5% and 40%. This is because the authors assumed that clinicians would investigate patients with unresponsive dyspepsia by endoscopy to obtain a definitive diagnosis, thus negating the effect of the cheaper noninvasive test [68]. If endoscopy is restricted, this may alter the results of the model [68].…”