The cost-effectiveness of diagnostic testing strategies for Helicobacter pylori

摘要: OBJECTIVE: Several noninvasive methods are now available for diagnosing Helicobacter pylori infection. Because the prevalence of H. infection is variable in patients requiring testing, optimal testing strategies may vary under different conditions. The aim this study was to evaluate cost-effectiveness competing diagnostic with varying prevalence. METHODS: A decision analysis performed comparing costs per number correct diagnoses achieved by alternative sequential strategies. Estimates and test characteristics were derived from a systematic review MEDLINE bibliographic database. Cost estimates 2000 Medicare Fee Schedule. RESULTS: The enzyme-linked immunosorbent assay (ELISA) had lowest cost diagnosis at low (30%), intermediate (60%), high (90%) ($90–$95/correct diagnosis), but its accuracy (80–84%). At stool more accurate (93%), an average $126–$127 diagnosis. Additional confirmatory positive or negative tests increased test, incremental costs. ELISA preferable when rates very (90%), using urea breath 96%, modest If $82, became testing. fell $39 then all rates. Fingerstick whole blood not cost-effective. CONCLUSIONS: The choice initial detection depends on value placed accuracy. Although results ratios, low-intermediate pretest probability infection, provides accuracy,