title: Cost-effectiveness analysis of universal noninvasive testing for post-treatment confirmation of Helicobacter pylori eradication and the impact of patient adherence.
abstract: BACKGROUND
  The treatment failure rate for Helicobacter pylori eradication therapy is ~20% due to poor patient compliance and increased antibiotic resistance. This analysis assessed the cost-effectiveness of universal post-treatment testing to confirm eradication of H. pylori infection in adults.
  
  
  METHODS
  Decision-analytic models evaluated the cost-effectiveness of universal post-treatment testing (urea breath test [UBT] or monoclonal fecal antigen test [mFAT]) vs no testing (Model 1), and UBT vs mFAT after adjusting for patient adherence to testing (Model 2) in adults who previously received first-line antimicrobial therapy. Patients testing positive received second-line quadruple therapy; no further action was taken for those testing negative or with no testing (Model 1) or for those nonadherent to testing (Model 2). In addition to testing costs, excess lifetime costs and reduced quality-adjusted life-years (QALYs) due to continuing H. pylori infection were considered in the model.
  
  
  RESULTS
  Expected total costs per patient were higher for post-treatment testing (UBT: US$325.76; mFAT: US$242.12) vs no testing (US$182.41) in Model 1 and for UBT (US$336.75) vs mFAT (US$326.24) in Model 2. Expected QALYs gained per patient were 0.71 and 0.72 for UBT and mFAT, respectively, vs no testing (Model 1), and the same was 0.37 for UBT vs mFAT (Model 2). The estimated incremental costs per QALY gained for post-treatment testing vs no testing were US$82.90-US$202.45 and, after adjusting for adherence, US$28.13 for UBT vs mFAT.
  
  
  CONCLUSIONS
  Universal post-treatment testing was found to be cost-effective for confirming eradication of H. pylori infection following first-line therapy. Better adherence to UBT relative to mFAT was the key to its cost-effectiveness.
authors.affiliation: Otsuka America Pharmaceutical, Inc, Princeton, NJ, USA.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Boklage
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Mangel
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Ramamohan
authors.affiliation: RTI Health Solutions, Research Triangle Park, NC, USA.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Mladsi
authors.affiliation: Otsuka America Pharmaceutical, Inc, Princeton, NJ, USA.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
keywords: decision-analytic modeling; health-economic; infectious disease