Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori "test and treat" strategy for patients with suspected peptic ulcer disease?
OBJECTIVE
Current clinical consensus supports an initial Helicobacter pylori (HP) "test and treat" approach when compared to immediate endoscopy for patients with suspected peptic ulcer disease. Alternative diagnostic approaches that incorporate upper GI radiography (UGI) have not been previously evaluated. We sought to determine the cost effectiveness of UGI compared to a HP test and treat strategy, incorporating recent data addressing the reduced prevalence of HP, lower cost of diagnostic interventions, and reduced attribution of PUD to HP.


METHODS
Using decision analysis, three diagnostic and treatment strategies were evaluated: 1) Test and Treat--initial HP serology, treat patients who test positive with HP eradication and antiulcer therapy; 2) Initial UGI series--treat all patients with documented ulcer disease with HP eradication and antiulcer therapy; and 3) Initial UGI series, HP serology if ulcer present--treat ulcer and HP based on diagnostic test results.


RESULTS
The estimated cost per ulcer cured for each strategy were as follows: test and treat, $3,025; initial UGI, $3,690; and UGI with serology, $3,790. The estimated cost per patient treatment were: test and treat, $498; initial UGI, $610; and UGI with serology, $620. When UGI reimbursement was decreased to less than $50, the UGI strategies yielded a lower cost per patient treated than the test and treat strategy.


CONCLUSIONS
At the current level of reimbursement, UGI should not be considered a cost-effective alternative to the HP test and treat strategy for the initial evaluation of patients with suspected peptic ulcer disease.
Rich
M
M
Department of Internal Medicine, and Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies, University of Michigan School of Medicine, Ann Arbor, USA.
Scheiman
J M
JM
Tierney
W
W
Fendrick
A M
AM
D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016481:Helicobacter Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D018803:Models, Economic; D010437:Peptic Ulcer / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000191:economics; D011237:Predictive Value of Tests; D011859:Radiography; D012008:Recurrence; D012680:Sensitivity and Specificity
D000897:Anti-Ulcer Agents