Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis
Background and Aims: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and upper gastrointestinal bleeding. Testing for and eradication of H. pylori reduces the risk of future PUD-related complications including readmission for gastrointestinal bleeding. Our aim was to d...
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Elsevier
2025-01-01
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| Series: | Gastro Hep Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772572324001985 |
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| author | Michael G. Artin Josephine Soddano Sheila D. Rustgi Zainab Aziz Francesca Lim Jeong Yun Yang Myles A. Ingram John T. Nathanson John Y. Kao Chin Hur |
| author_facet | Michael G. Artin Josephine Soddano Sheila D. Rustgi Zainab Aziz Francesca Lim Jeong Yun Yang Myles A. Ingram John T. Nathanson John Y. Kao Chin Hur |
| author_sort | Michael G. Artin |
| collection | DOAJ |
| description | Background and Aims: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and upper gastrointestinal bleeding. Testing for and eradication of H. pylori reduces the risk of future PUD-related complications including readmission for gastrointestinal bleeding. Our aim was to determine the most cost-effective testing strategy for H. pylori in patients hospitalized with bleeding peptic ulcers. Methods: We developed a Markov cohort model to compare the following 6 H. pylori testing strategies: no testing, histology, rapid urease test, stool antigen test, urea breath test (UBT), and serology. Histology and rapid urease test require biopsies, while stool antigen test, UBT, and serology do not. We assumed a 17% H. pylori prevalence in patients admitted with bleeding ulcers. Model outcomes included hospitalizations for rebleeds, number needed to treat to avoid another hospitalization, life expectancy, total cost, quality-adjusted life years, and incremental cost-effectiveness ratios. Results: Compared to no testing, UBT resulted in a gain of 0.02 quality-adjusted life years, total cost savings of $2140 per patient, and 1675 hospitalizations avoided per 10,000 patients per year. Additionally, the number needed to treat to avoid an additional hospitalization over 35 years was 167. UBT was the preferred strategy as it was both less costly and more effective than no testing. Conclusion: Our findings suggest that UBT is the cost-effective strategy to identify H. pylori in patients admitted with PUD. Noninvasive H. pylori testing at the point of care or during inpatient admission should be considered, as it presents limited risk to patients and offers potential clinical benefits. |
| format | Article |
| id | doaj-art-35108dbb1c5f4e4182158b1d1a5c8541 |
| institution | Kabale University |
| issn | 2772-5723 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj-art-35108dbb1c5f4e4182158b1d1a5c85412025-02-08T05:01:42ZengElsevierGastro Hep Advances2772-57232025-01-0144100602Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness AnalysisMichael G. Artin0Josephine Soddano1Sheila D. Rustgi2Zainab Aziz3Francesca Lim4Jeong Yun Yang5Myles A. Ingram6John T. Nathanson7John Y. Kao8Chin Hur9Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDepartment of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New YorkDepartment of Medicine, Columbia University Irving Medical Center, New York, New YorkDepartment of Medicine, Columbia University Irving Medical Center, New York, New YorkDepartment of Medicine, Columbia University Irving Medical Center, New York, New YorkDepartment of Medicine, Columbia University Irving Medical Center, New York, New YorkDivision of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New YorkDivision of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganDepartment of Medicine, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Correspondence: Address correspondence to: Chin Hur, MD, MPH, Columbia University Irving Medical Center, 622 W 168th Street, PH9-105, New York, New York 10032.Background and Aims: Helicobacter pylori (H. pylori) is a major cause of peptic ulcer disease (PUD) and upper gastrointestinal bleeding. Testing for and eradication of H. pylori reduces the risk of future PUD-related complications including readmission for gastrointestinal bleeding. Our aim was to determine the most cost-effective testing strategy for H. pylori in patients hospitalized with bleeding peptic ulcers. Methods: We developed a Markov cohort model to compare the following 6 H. pylori testing strategies: no testing, histology, rapid urease test, stool antigen test, urea breath test (UBT), and serology. Histology and rapid urease test require biopsies, while stool antigen test, UBT, and serology do not. We assumed a 17% H. pylori prevalence in patients admitted with bleeding ulcers. Model outcomes included hospitalizations for rebleeds, number needed to treat to avoid another hospitalization, life expectancy, total cost, quality-adjusted life years, and incremental cost-effectiveness ratios. Results: Compared to no testing, UBT resulted in a gain of 0.02 quality-adjusted life years, total cost savings of $2140 per patient, and 1675 hospitalizations avoided per 10,000 patients per year. Additionally, the number needed to treat to avoid an additional hospitalization over 35 years was 167. UBT was the preferred strategy as it was both less costly and more effective than no testing. Conclusion: Our findings suggest that UBT is the cost-effective strategy to identify H. pylori in patients admitted with PUD. Noninvasive H. pylori testing at the point of care or during inpatient admission should be considered, as it presents limited risk to patients and offers potential clinical benefits.http://www.sciencedirect.com/science/article/pii/S2772572324001985H. pyloriPeptic Ulcer DiseaseGI BleedingHospitalizationCost-Effectiveness Analysis |
| spellingShingle | Michael G. Artin Josephine Soddano Sheila D. Rustgi Zainab Aziz Francesca Lim Jeong Yun Yang Myles A. Ingram John T. Nathanson John Y. Kao Chin Hur Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis Gastro Hep Advances H. pylori Peptic Ulcer Disease GI Bleeding Hospitalization Cost-Effectiveness Analysis |
| title | Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis |
| title_full | Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis |
| title_fullStr | Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis |
| title_full_unstemmed | Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis |
| title_short | Initial Diagnostic Strategies for Helicobacter Pylori in Patients With Bleeding Peptic Ulcers Undergoing Endoscopy: A Cost-Effectiveness Analysis |
| title_sort | initial diagnostic strategies for helicobacter pylori in patients with bleeding peptic ulcers undergoing endoscopy a cost effectiveness analysis |
| topic | H. pylori Peptic Ulcer Disease GI Bleeding Hospitalization Cost-Effectiveness Analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2772572324001985 |
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