Helicobacter pylori-associated ulcer bleeding: should we test for eradication after treatment?
BACKGROUND
Eradication of Helicobacter pylori after peptic ulcer haemorrhage reduces the risk of recurrence. Because H. pylori treatment is very effective, it is unclear whether testing to confirm eradication is worthwhile.


OBJECTIVE
To examine whether patients with H. pylori-associated peptic ulcer haemorrhage should be tested for successful eradication after completion of antibiotic therapy.


METHODS
A Markov cost-effectiveness model was developed to compare testing vs. non-testing of H. pylori eradication in peptic ulcer haemorrhage. Probability estimates and average costs were derived from published information.


RESULTS
Testing for H. pylori eradication resulted in a benefit of 0.07 quality-adjusted life-years and cost 836 US dollars less than the strategy of not confirming eradication. Testing remained the superior strategy when varying the model regarding age, the initial success of eradication, various test and retreatment strategies, and the rate and costs of recurrent bleeding. Assuming a high eradication rate (95%), the test strategy becomes more expensive only if the cost of H. pylori testing reaches 265 US dollars; however, even under these conditions it remains cost-effective.


CONCLUSIONS
Patients with H. pylori-associated peptic ulcer bleeding should be tested to confirm eradiation of H. pylori after completion of antibiotic treatment.
Pohl
H
H
VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT, USA. heiko.pohl@dartmouth.edu
Finlayson
S R G
SR
Sonnenberg
A
A
Robertson
D J
DJ
D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D010438:Peptic Ulcer Hemorrhage / Q000382:microbiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012008:Recurrence