Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2010

Open Access 01-12-2010 | Research article

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

Authors: Kyland P Holmes, John C Fang, Brian R Jackson

Published in: BMC Health Services Research | Issue 1/2010

Login to get access

Abstract

Background

Initial 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.

Methods

A 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.

Results

Under 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.

Conclusions

Under 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.
Appendix
Available only for authorised users
Literature
1.
Talley NJ, Vakil NB, Moayyedi P: American gastroenterological association technical review on the evaluation of dyspepsia. Gastroenterology. 2005, 129 (5): 1756-80. 10.1053/j.gastro.2005.09.020.CrossRefPubMed
2.
Talley NJ: American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology. 2005, 129 (5): 1753-5. 10.1053/j.gastro.2005.09.019.CrossRefPubMed
3.
Chey WD, Wong BC: American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007, 102 (8): 1808-25. 10.1111/j.1572-0241.2007.01393.x.CrossRefPubMed
4.
Adamsson I, Nord CE, Lundquist P, Sjostedt S, Edlund C: Comparative effects of omeprazole, amoxycillin plus metronidazole versus omeprazole, clarithromycin plus metronidazole on the oral, gastric and intestinal microflora in Helicobacter pylori-infected patients. J Antimicrob Chemother. 1999, 44 (5): 629-40. 10.1093/jac/44.5.629.CrossRefPubMed
5.
Adamsson I, Edlund C, Nord CE: Impact of treatment of Helicobacter pylori on the normal gastrointestinal microflora. Clin Microbiol Infect. 2000, 6 (4): 175-7. 10.1111/j.1469-0691.2000.00028.x.CrossRefPubMed
6.
Calvet X, Gene E, Lopez T, Gisbert JP: What is the optimal length of proton pump inhibitor-based triple therapies for H. pylori? A cost-effectiveness analysis. Aliment Pharmacol Ther. 2001, 15 (7): 1067-76. 10.1046/j.1365-2036.2001.01031.x.CrossRefPubMed
7.
Childs S, Roberts A, Meineche-Schmidt V, de WN, Rubin G: The management of Helicobacter pylori infection in primary care: a systematic review of the literature. Fam Pract. 2000, 17 (Suppl 2): S6-11. 10.1093/fampra/17.suppl_2.S6.CrossRefPubMed
8.
Choi J, Jang JY, Kim JS, Park HY, Choe YH, Kim KM: Efficacy of two triple eradication regimens in children with Helicobacter pylori infection. J Korean Med Sci. 2006, 21 (6): 1037-40. 10.3346/jkms.2006.21.6.1037.CrossRefPubMedPubMedCentral
9.
Cutler AF, Vakil N: Evolving therapy for Helicobacter pylori infection: efficacy and economic impact in the treatment of patients with duodenal ulcer disease. Am J Manag Care. 1997, 3 (10): 1528-34.PubMed
10.
Duggan AE, Tolley K, Hawkey CJ, Logan RF: Varying efficacy of Helicobacter pylori eradication regimens: cost effectiveness study using a decision analysis model. BMJ. 1998, 316 (7145): 1648-54.CrossRefPubMedPubMedCentral
11.
Ford AC, Delaney BC, Forman D, Moayyedi P: Eradication therapy in Helicobacter pylori positive peptic ulcer disease: systematic review and economic analysis. Am J Gastroenterol. 2004, 99 (9): 1833-55. 10.1111/j.1572-0241.2004.40014.x.CrossRefPubMed
12.
Laine L, Schoenfeld P, Fennerty MB: Therapy for Helicobacter pylori in patients with nonulcer dyspepsia. A meta-analysis of randomized, controlled trials. Ann Intern Med. 2001, 134 (5): 361-9.CrossRefPubMed
13.
Malfertheiner P, Megraud F, O'Morain C, Hungin AP, Jones R, Axon A, et al: Current concepts in the management of Helicobacter pylori infection--the Maastricht 2-2000 Consensus Report. Aliment Pharmacol Ther. 2002, 16 (2): 167-80. 10.1046/j.1365-2036.2002.01169.x.CrossRefPubMed
14.
Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, et al: Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007, 56 (6): 772-81. 10.1136/gut.2006.101634.CrossRefPubMed
15.
McColl KE, Dickson A, El-Nujumi A, El-Omar E, Kelman A: Symptomatic benefit 1-3 years after H. pylori eradication in ulcer patients: impact of gastroesophageal reflux disease. Am J Gastroenterol. 2000, 95 (1): 101-5.PubMed
16.
17.
Moayyedi P, Soo S, Deeks J, Forman D, Mason J, Innes M, et al: Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. Dyspepsia Review Group. BMJ. 2000, 321 (7262): 659-64. 10.1136/bmj.321.7262.659.CrossRefPubMedPubMedCentral
18.
Moayyedi P, Deeks J, Talley NJ, Delaney B, Forman D: An update of the Cochrane systematic review of Helicobacter pylori eradication therapy in nonulcer dyspepsia: resolving the discrepancy between systematic reviews. Am J Gastroenterol. 2003, 98 (12): 2621-6. 10.1111/j.1572-0241.2003.08724.x.CrossRefPubMed
19.
Raghunath AS, Hungin AP, Wooff D, Childs S: Systematic review: the effect of Helicobacter pylori and its eradication on gastro-oesophageal reflux disease in patients with duodenal ulcers or reflux oesophagitis. Aliment Pharmacol Ther. 2004, 20 (7): 733-44. 10.1111/j.1365-2036.2004.02172.x.CrossRefPubMed
20.
Sonnenberg A, Pauly MP, Levenson SD, Schwartz JS: Antibiotic therapy of Helicobacter pylori infection reduces healthcare expenditures related to duodenal ulcer. Am J Manag Care. 1999, 5 (1): 53-9.PubMed
21.
Spiegel BM, Vakil NB, Ofman JJ: Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology. 2002, 122 (5): 1270-85. 10.1053/gast.2002.33019.CrossRefPubMed
22.
Talley NJ, Vakil N: Guidelines for the management of dyspepsia. Am J Gastroenterol. 2005, 100 (10): 2324-37. 10.1111/j.1572-0241.2005.00225.x.CrossRefPubMed
23.
Tytgat GN: Treatment of Helicobacter pylori infection: management of patients with ulcer disease by general practitioners and gastroenterologists. Gut. 1998, 43 (Suppl 1): S24-S26. 10.1136/gut.43.2008.S24.CrossRefPubMedPubMedCentral
24.
Vakil N, Connor J: Helicobacter pylori eradication: equivalence trials and the optimal duration of therapy. Am J Gastroenterol. 2005, 100 (8): 1702-3. 10.1111/j.1572-0241.2005.50615.x.CrossRefPubMed
25.
Vakil N, Megraud F: Eradication therapy for Helicobacter pylori. Gastroenterology. 2007, 133 (3): 985-1001. 10.1053/j.gastro.2007.07.008.CrossRefPubMed
26.
Chey WD, Fendrick AM: Noninvasive Helicobacter pylori testing for the "testand-treat" strategy: a decision analysis to assess the effect of past infection on test choice. Arch Intern Med. 2001, 161 (17): 2129-32. 10.1001/archinte.161.17.2129.CrossRefPubMed
27.
Demiray E, Yilmaz O, Sarkis C, Soyturk M, Simsek I: Comparison of invasive methods and two different stool antigen tests for diagnosis of H pylori infection in patients with gastric bleeding. World J Gastroenterol. 2006, 12 (26): 4206-10.CrossRefPubMedPubMedCentral
28.
Gee I, Playford RJ, Turner D, Sheldon N, Wicks AC: Cost analysis of breath test versus endoscopy for dyspepsia. Digestion. 2002, 65 (4): 207-12. 10.1159/000063821.CrossRefPubMed
29.
Hsu PI, Lai KH, Tseng HH, Liu YC, Yen MY, Lin CK, et al: Correlation of serum immunoglobulin G Helicobacter pylori antibody titers with histologic and endoscopic findings in patients with dyspepsia. J Clin Gastroenterol. 1997, 25 (4): 587-91. 10.1097/00004836-199712000-00007.CrossRefPubMed
30.
Lehmann F, Drewe J, Terracciano L, Stuber R, Frei R, Beglinger C: Comparison of stool immunoassay with standard methods for detecting Helicobacter pylori infection. BMJ. 1999, 319 (7222): 1409.CrossRefPubMedPubMedCentral
31.
Ogata SK, Kawakami E, Patricio FR, Pedroso MZ, Santos AM: Evaluation of invasive and non-invasive methods for the diagnosis of Helicobacter pylori infection in symptomatic children and adolescents. Sao Paulo Med J. 2001, 119 (2): 67-71. 10.1590/S1516-31802001000200006.CrossRefPubMed
32.
Zaitoun AM: Histology compared with chemical testing for urease for rapid detection of Helicobacter pylori in gastric biopsy specimens. J Clin Pathol. 1993, 46 (7): 684-5. 10.1136/jcp.46.7.684.CrossRefPubMedPubMedCentral
33.
Andrews J, Marsden B, Brown D, Wong VS, Wood E, Kelsey M: Comparison of three stool antigen tests for Helicobacter pylori detection. J Clin Pathol. 2003, 56 (10): 769-71. 10.1136/jcp.56.10.769.CrossRefPubMedPubMedCentral
34.
Braden B, Teuber G, Dietrich CF, Caspary WF, Lembcke B: Comparison of new faecal antigen test with (13)C-urea breath test for detecting Helicobacter pylori infection and monitoring eradication treatment: prospective clinical evaluation. BMJ. 2000, 320 (7228): 148-10.1136/bmj.320.7228.148.CrossRefPubMedPubMedCentral
35.
Gisbert JP, Trapero M, Pajares JM: Evaluation of 3 different tests for the detection of stool antigens to confirm Helicobacter pylori eradication after treatment. A pilot study. Gastroenterol Hepatol. 2005, 28 (10): 615-8. 10.1016/S0210-5705(05)71524-7.CrossRefPubMed
36.
Laine L, Suchower L, Johnson E, Ronca P, Neil G: Accuracy of CLOtest after Helicobacter pylori therapy. Gastrointest Endosc. 1998, 47 (3): 250-3. 10.1016/S0016-5107(98)70321-9.CrossRefPubMed
37.
Li YH, Guo H, Zhang PB, Zhao XY, Da SP: Clinical value of Helicobacter pylori stool antigen test, ImmunoCard STAT HpSA, for detecting H pylori infection. World J Gastroenterol. 2004, 10 (6): 913-4.PubMedPubMedCentral
38.
Reilly TG, Poxon V, Sanders DS, Elliott TS, Walt RP: Comparison of serum, salivary, and rapid whole blood diagnostic tests for Helicobacter pylori and their validation against endoscopy based tests. Gut. 1997, 40 (4): 454-8.CrossRefPubMedPubMedCentral
39.
Sabbi T, De AP, Colistro F, Dall'Oglio L, di Abriola GF, Castro M: Efficacy of noninvasive tests in the diagnosis of Helicobacter pylori infection in pediatric patients. Arch Pediatr Adolesc Med. 2005, 159 (3): 238-41. 10.1001/archpedi.159.3.238.CrossRefPubMed
40.
Shepherd AJ, Williams CL, Doherty CP, Hossack M, Preston T, McColl KE, et al: Comparison of an enzyme immunoassay for the detection of Helicobacter pylori antigens in the faeces with the urea breath test. Arch Dis Child. 2000, 83 (3): 268-70. 10.1136/adc.83.3.268.CrossRefPubMedPubMedCentral
41.
42.
Vaira D, Vakil N, Menegatti M, van't HB, Ricci C, Gatta L, et al: The stool antigen test for detection of Helicobacter pylori after eradication therapy. Ann Intern Med. 2002, 136 (4): 280-7.CrossRefPubMed
43.
Veijola L, Myllyluoma E, Korpela R, Rautelin H: Stool antigen tests in the diagnosis of Helicobacter pylori infection before and after eradication therapy. World J Gastroenterol. 2005, 11 (46): 7340-4.CrossRefPubMedPubMedCentral
44.
Vakil N, Rhew D, Soll A, Ofman JJ: The cost-effectiveness of diagnostic testing strategies for Helicobacter pylori. Am J Gastroenterol. 2000, 95 (7): 1691-8.PubMed
45.
Mushlin AI, Ruchlin HS, Callahan MA: Costeffectiveness of diagnostic tests. Lancet. 2001, 358 (9290): 1353-5. 10.1016/S0140-6736(01)06417-0.CrossRefPubMed
46.
Raghunath A, Hungin AP, Wooff D, Childs S: Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ. 2003, 326 (7392): 737-10.1136/bmj.326.7392.737.CrossRefPubMedPubMedCentral
47.
Crabtree JE, Shallcross TM, Heatley RV, Wyatt JI: Evaluation of a commercial ELISA for serodiagnosis of Helicobacter pylori infection. J Clin Pathol. 1991, 44 (4): 326-8. 10.1136/jcp.44.4.326.CrossRefPubMedPubMedCentral
48.
Duggan A, Logan R: Validation of a rapid whole blood test for diagnosing Helicobacter pylori infection. Conflicting results from the Helisal test. BMJ. 1997, 314 (7095): 1688-9.CrossRefPubMedPubMedCentral
49.
Karvar S, Karch H, Frosch M, Burghardt W, Gross U: Use of serum-specific immunoglobulins A and G for detection of Helicobacter pylori infection in patients with chronic gastritis by immunoblot analysis. J Clin Microbiol. 1997, 35 (12): 3058-61.PubMedPubMedCentral
50.
Talley NJ, Newell DG, Ormand JE, Carpenter HA, Wilson WR, Zinsmeister AR, et al: Serodiagnosis of Helicobacter pylori: comparison of enzyme-linked immunosorbent assays. J Clin Microbiol. 1991, 29 (8): 1635-9.PubMedPubMedCentral
51.
van Der EA, van Der Hulst RW, Roorda P, Tytgat GN, Dankert J: Evaluation of three commercial serological tests with different methodologies to assess Helicobacter pylori infection. J Clin Microbiol. 1999, 37 (12): 4150-2.
52.
Erzin Y, Altun S, Dobrucali A, Aslan M, Erdamar S, Dirican A, et al: Evaluation of two enzyme immunoassays for detecting Helicobacter pylori in stool specimens of dyspeptic patients after eradication therapy. J Med Microbiol. 2005, 54 (Pt 9): 863-6. 10.1099/jmm.0.45914-0.CrossRefPubMed
53.
Gisbert JP, Pajares JM: Diagnosis of Helicobacter pylori infection by stool antigen determination: a systematic review. Am J Gastroenterol. 2001, 96 (10): 2829-38. 10.1111/j.1572-0241.2001.04235.x.CrossRefPubMed
54.
Gisbert JP, Pajares JM: Stool antigen test for the diagnosis of Helicobacter pylori infection: a systematic review. Helicobacter. 2004, 9 (4): 347-68. 10.1111/j.1083-4389.2004.00235.x.CrossRefPubMed
55.
Gisbert JP, de la MF, Abraira V: Accuracy of monoclonal stool antigen test for the diagnosis of H. pylori infection: a systematic review and meta-analysis. Am J Gastroenterol. 2006, 101 (8): 1921-30. 10.1111/j.1572-0241.2006.00668.x.CrossRefPubMed
56.
Syam AF, Rani AA, Abdullah M, Manan C, Makmun D, Simadibrata M, et al: Accuracy of Helicobacter pylori stool antigen for the detection of Helicobacter pylori infection in dyspeptic patients. World J Gastroenterol. 2005, 11 (3): 386-8.CrossRefPubMedPubMedCentral
57.
Moayyedi P, Soo S, Deeks J, Delaney B, Harris A, Innes M, et al: Eradication of Helicobacter pylori for non-ulcer dyspepsia. Cochrane Database Syst Rev. 2006, CD002096-2
Metadata
Title
Cost-effectiveness of six strategies for Helicobacter pyloridiagnosis and management in uninvestigated dyspepsia assuming a high resource intensity practice pattern
Authors
Kyland P Holmes
John C Fang
Brian R Jackson
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2010
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-10-344

Other articles of this Issue 1/2010

BMC Health Services Research 1/2010 Go to the issue

Research article

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

Research article

Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study

Research article

The relationship between safety net activities and hospital financial performance

Research article

Adjustment of nursing home quality indicators

Research article

Health plan administrative records versus birth certificate records: quality of race and ethnicity information in children

Research article

Chronology of prescribing error during the hospital stay and prediction of pharmacist's alerts overriding: a prospective analysis