Non-invasive Testing for Helicobacter pylori in Patients Hospitalized with Peptic Ulcer Hemorrhage: A Cost-Effectiveness Analysis
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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.
KeywordsHelicobacter pylori Peptic ulcer hemorrhage Cost-benefit analysis Breath tests/methods Carbon isotopes/diagnostic use
- H. pylori
Rapid urease test
Peptic ulcer hemorrhage
Urea breath test
Upper gastrointestinal bleed
Diagnoses Related Group
Current procedural terminology
Incremental cost-effectiveness ratio
Non-steroidal anti-inflammatory drugs
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