Non-invasive testing for Helicobacter pylori in patients hospitalized with peptic ulcer hemorrhage: a cost-effectiveness analysis.
OBJECTIVE
Guidelines recommend routine invasive screening for Helicobacter pylori in patients with peptic ulcer hemorrhage (PUH). However, compliance with screening remains suboptimal. The aim of this study was to determine if a simplified approach based on noninvasive screening is cost effective in PUH.


RESULTS
In the base case, post-endoscopy urea breath test (UBT) dominated the invasive testing with 34 fewer hemorrhages and cost savings of $406,600 in a cohort of 10,000 patients. When compliance with invasive testing decreases to 60%, post-endoscopy UBT leads to 109 fewer hemorrhages and cost savings of $1,089,600. The invasive strategy becomes the preferred choice if the sensitivity of UBT reduces to <75%, such as in patients taking proton-pump inhibitors (PPI) before hospitalization.


CONCLUSIONS
Post-endoscopy UBT is cost effective in PPI-naïve patients presenting with PUH. This strategy, once prospectively validated, can prove to be a preferred approach in institutions where compliance with invasive testing is suboptimal.
Atreja
Ashish
A
Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH, USA.
Fu
Alex Z
AZ
Sanaka
Madhusudan R
MR
Vargo
John J
JJ
D001944:Breath Tests; D002247:Carbon Isotopes; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D005773:Gastroscopy / Q000191:economics*; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D016480:Helicobacter pylori; D017721:Hospital Costs; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D010343:Patient Admission / Q000706:statistics & numerical data; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology*; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use; D012680:Sensitivity and Specificity
D002247:Carbon Isotopes; D054328:Proton Pump Inhibitors