Cost-Effectiveness Analysis ofHelicobacter pyloriDiagnostic Methods in Patients with Atrophic Gastritis

Abstract

Background. There are several diagnostic methods forHelicobacter pylori (H. pylori)infection. A cost-effective analysis is needed to decide on the optimal diagnostic method. The aim of this study was to determine a cost-effective diagnostic method in patients with atrophic gastritis (AG).Methods. A decision-analysis model including seven diagnostic methods was constructed for patients with AG diagnosed by esophagogastroduodenoscopy. Expected values of cost and effectiveness were calculated for each test.Results. If the prevalence ofH. pyloriin the patients with AG is 85% and CAM-resistantH. pyloriis 30%, histology, stoolH. pyloriantigen (SHPAg), bacterial culture (BC), and urineH. pyloriantibody (UHPAb) were dominated by serumH. pyloriIgG antibody (SHPAb), rapid urease test (RUT), and urea breath test (UBT). Among three undominated methods, the incremental cost-effective ratios (ICER) of RUT versus SHPAb and UBT versus RUT were $214 and $1914, respectively. If the prevalence of CAM-sensitiveH. pyloriwas less than 55%, BC was not dominated, but itsH. pylorieradication success rate was 0.86.Conclusions. RUT was the most cost-effective at the current prevalence of CAM-resistantH. pylori. BC could not be selected due to its poor effectiveness even if CAM-resistantH. pyloriwas more than 45%.