Cost-effectiveness of noninvasive testing and treatment strategies for H. pylori infection in children with dyspepsia.
OBJECTIVE
We sought to model the cost-effectiveness of endoscopy, noninvasive testing and treatment strategies for Helicobacter pylori infection in children with recurrent abdominal pain in two health care systems, those of the United States and Finland.


METHODS
Initial serological testing and treatment was compared to empirical treatment with antimicrobials, endoscopy with rapid urease testing, and 13C urea breath testing. Key assumptions and ranges were obtained from the published literature. Costs were determined for the acquisition of various tests and actual reimbursement figures were used for procedural costs.


RESULTS
The disease management costs were very similar for both endoscopy ($643.00) and serology ($646.00) in the United States. In Finland, endoscopy ($173.00) was less expensive than serology ($192.00). The 13C urea breath test was the most expensive procedure in the United States. Sensitivity analysis demonstrated that serological testing became the preferred path if its cost was < $42 in the United States. Empirical treatment of children with dyspepsia was not cost-effective in either country. Sensitivity analysis showed that when prevalence of infection was > 53% in children with recurrent abdominal pain, empirical therapy with endoscopy reserved for failures was the optimal path.


CONCLUSIONS
In developed countries like the United States and Finland, significant cost savings are unlikely with an initial test and treat strategy based on serology. Noninvasive testing and treatment of H. pylori infection can be cost-effective in populations with highly prevalent rates of infection.
Vakil
N
N
Department of Medicine, University of Wisconsin Medical School, Milwaukee 53233, USA.
Ashorn
M
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001944:Breath Tests; D002250:Carbon Radioisotopes; D002648:Child; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000150:complications*; D004724:Endoscopy / Q000191:economics; D005387:Finland; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D009010:Monte Carlo Method; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000191:economics; D014481:United States; D014508:Urea / Q000032:analysis
D000900:Anti-Bacterial Agents; D002250:Carbon Radioisotopes; D014508:Urea