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Noninvasive Helicobacter pylori Testing for the "Test-and-Treat" Strategy
A Decision Analysis to Assess the Effect of Past Infection on Test Choice
William D. Chey, MD, FACP, FACG;
A. Mark Fendrick, MD
Arch Intern Med. 2001;161:2129-2132.
Background Clinical guidelines support a noninvasive Helicobacter
pylori "test-and-treat" strategy for individuals with uncomplicated
dyspepsia. However, consensus is lacking regarding the preferred noninvasive
testing method.
Objective To use decision analytic modeling to estimate the clinical and economic
outcomes associated with noninvasive tests designed to detect either H pylori antibody or active H pylori infection.
Design Decision analytic model.
Patients A simulated patient cohort with uncomplicated dyspepsia.
Interventions The simulated dyspepsia cohort underwent antibody testing or testing
to detect active H pylori infection (active testing).
Individuals testing positive received eradication therapy.
Main Outcome Measures Appropriate and inappropriate treatment prescribed, cost per patient
treated, incremental cost per unnecessary treatment avoided.
Results Active testing led to a substantial reduction in unnecessary treatment
for patients without active infection (antibody, 23.7; active, 1.4 per 100
patients) at an incremental cost of $37 per patient. The clinical advantage
and cost-effectiveness of active testing was enhanced as the percentage of
individuals with a positive antibody test result from past, but not current,
infection increased.
Conclusions Active testing for H pylori infection significantly
decreases the inappropriate use of antimicrobial therapy when compared with
antibody testing. The advantages of active testing should be enhanced as the
widespread use of antimicrobial agents increases the proportion of patients
with antibody to H pylori, but without active infection.
From the Divisions of Gastroenterology (Dr Chey) and General Medicine
(Dr Fendrick), and the Consortium for Health Outcomes, Innovation, and Cost-effectiveness
Studies (CHOICES) (Dr Fendrick), University of Michigan Health System, Ann
Arbor.
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Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2001;161(17):2155-2156.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report
Malfertheiner et al.
Gut 2007;56:772-781.
ABSTRACT
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