Cost-effectiveness and long-term impact of Helicobacter pylori 'test and treat' service in reducing open access endoscopy referrals.
BACKGROUND
We have shown that the introduction of a carbon urea breath test (13C-UBT) service for Helicobacter pylori screening and eradication is effective in reducing the rate of open access endoscopy referrals in patients aged < 40 years in the short term. This has been substantiated by several randomized controlled trials comparing a 'test and treat' strategy with early endoscopy in these patients. However, the long-term impact of such a strategy is not established.


OBJECTIVE
To ascertain the influence of 13C-UBT services on open access endoscopy referral rates in dyspeptic patients under the age of 40 years over a period of 5 years.


METHODS
Retrospective analysis of open access endoscopy referral rates between August 1990 and July 2000. Cost minimization analysis was performed with a Decision Analysis Model using Treeage Data 3.5.


RESULTS
The total number of open access referrals for endoscopy during 1990-1995 was between 765 and 1325 per year. The proportion of endoscopies performed in patients < 40 years ranged between 33.4% and 34.6%. The total number of endoscopy referrals during 1995-2000 after the introduction of the 13C-UBT services was between 1178 and 1321 per year. However, there was a sustained reduction in the proportion of patients aged < 40 years, ranging between 23.2% and 26.2% (Chi2 = 153.9, degrees of freedom = 9, P < 0.0001) during this period.


CONCLUSIONS
The H. pylori screening and treatment strategy using the 13C-UBT service results in a sustained reduction of the number of endoscopy referrals and is cost effective in dyspeptic patients under the age of 40 years, enabling better utilization of available resources.
Sreedharan
Aravamuthan
A
Department of Gastroenterology, Centre for Digestive Diseases, The General Infirmary at Leeds, UK.
Clough
Micheal
M
Hemingbrough
Elaine
E
Gatta
Luigi
L
Chalmers
Douglas M
DM
Axon
Anthony T R
AT
Moayyedi
Paul
P
D000328:Adult; D001944:Breath Tests; D002247:Carbon Isotopes; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004415:Dyspepsia / Q000382:microbiology* / Q000601:surgery; D005773:Gastroscopy / Q000191:economics* / Q000706:statistics & numerical data; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D016480:Helicobacter pylori; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D012017:Referral and Consultation; D012189:Retrospective Studies; D014508:Urea / Q000032:analysis
D002247:Carbon Isotopes; D014508:Urea