Digestive Diseases and Sciences

, Volume 55, Issue 5, pp 1356–1363 | Cite as

Non-invasive Testing for Helicobacter pylori in Patients Hospitalized with Peptic Ulcer Hemorrhage: A Cost-Effectiveness Analysis

  • Ashish Atreja
  • Alex Z. Fu
  • Madhusudan R. Sanaka
  • John J. Vargo
Original Article



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.


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.


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.


Helicobacter pylori Peptic ulcer hemorrhage Cost-benefit analysis Breath tests/methods Carbon isotopes/diagnostic use 


H. pylori

Helicobacter pylori


Rapid urease test


Peptic ulcer hemorrhage


Urea breath test


Proton-pump inhibitors


Upper gastrointestinal bleed


Diagnoses Related Group


Current procedural terminology


Incremental cost-effectiveness ratio


Non-steroidal anti-inflammatory drugs


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Ashish Atreja
    • 1
  • Alex Z. Fu
    • 2
  • Madhusudan R. Sanaka
    • 3
  • John J. Vargo
    • 3
  1. 1.Digestive Diseases InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Quantitative Health SciencesCleveland ClinicClevelandUSA
  3. 3.Digestive Diseases InstituteCleveland ClinicClevelandUSA

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