Clinical utility and cost effectiveness of Helicobacter pylori testing for patients with duodenal and gastric ulcers.
OBJECTIVE
current consensus guidelines recommend that all patients demonstrating either a gastric or duodenal ulcer be tested for Helicobacter pylori, the most common cause of ulcers. We determined the clinical utility and cost effectiveness of H. pylori testing in patients with duodenal and gastric ulcers.


METHODS
A retrospective evaluation and cost-effectiveness analysis of 565 consecutive patients with endoscopically demonstrated gastric or duodenal ulcers over a 4-yr period in a large, urban general hospital. The main outcome variables are the percentage of patients who had a gastric biopsy, the prevalence of H. pylori, and the cost effectiveness of testing (antral biopsy, CLO test, serum antibody, and urea breath test) for H. pylori.


RESULTS
Significantly more patients with endoscopically documented duodenal ulcers had an antral biopsy performed in 1993 and 1994 when compared with patients from 1991 and 1992 (p < 0.00001). For patients with gastric ulcers, biopsies were performed at a similar rate throughout this study. Overall, patients with duodenal and gastric ulcers demonstrated H. pylori 75% and 69% of the time, respectively. The total charges for biopsy documentation and treatment of H. pylori in all duodenal ulcer patients in this cohort was estimated at $25,135. If a biopsy for H. pylori had been performed in all patients the actual charges would have been $77,443. Conversely, charges would have been only $8085 had all patients been empirically treated for H. pylori based on the high pretest probability of infection.


CONCLUSIONS
Routine testing for H. pylori is very expensive, regardless of the diagnostic method used. Biopsy results do not provide clinically useful information in most patients with duodenal ulcers and may be misleading if falsely negative.
Greenberg
P D
PD
Division of Gastroenterology, Hepatology, and Clinical Nutrition, San Francisco General Hospital, California, USA.
Koch
J
J
Cello
J P
JP
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000032:analysis; D001706:Biopsy; D001944:Breath Tests / Q000379:methods; D004396:Coloring Agents; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000209:etiology*; D004724:Endoscopy; D005069:Evaluation Studies as Topic; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000201:enzymology / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000175:diagnosis / Q000209:etiology*; D014508:Urea; D014510:Urease / Q000032:analysis
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D004396:Coloring Agents; D014508:Urea; D014510:Urease