BACKGROUND: Treatment failure rate for H. pylori eradication therapy is approximately 20% due to poorpatient compliance and increased antibiotic resistance. The objective of this study was to assess the costeffectiveness of universal post-treatment monitoring of H. pylori infection using urea breath tests (UBT) and fecal antigen tests (FAT) in adults.
METHODS: A decision-tree model was developed to evaluate the cost-effectiveness of UBT and FAT in universal post-treatment monitoring of H. pylori infection and to compare the cost-effectiveness of UBT and FAT after adjusting for patient compliance. Patients treated with one course of triple therapy were either retested or not re-tested. If the re-test was positive, the patient received a second line eradication treatment; no further action in the model was taken for those who re-tested negative or those who did not receive a re-test. Excess lifetime per patient costs (LTC) and reduced quality-adjusted life-years (QALYs), estimated with respect to patients without H. pylori infection, were applied to patients who continue to live with the H. pylori infection due to treatment failure, noncompliance, or false negative test results. Incremental cost-effectiveness ratios (ICERs) were calculated.
RESULTS: In the base-case scenario where patient compliance was assumed to be equivalent at 100%, the per treated patient costs of re-testing, physician visits and second-line eradication therapy were $270 for UBT, $189 for FAT and $0 for no-retest. The estimated excess LTC were $56 for UBT, $54 for FAT and $183 for noretest compared to those without H. pylori infection. QALYs gained per patient for re-test using UBT and FAT compared with no re-test were 0.71 and 0.72, respectively. ICERs of universal post-treatment monitoring were $201 per QALY gained using UBT and $82 using FAT compared to no-retest. After adjusting for patient compliance (86% for UBT and 48% for FAT) for post-treatment re-testing, the total cost of patient care was $337 for UBT and $327 for FAT. The estimated excess LTC compared to those without H. pylori infection were $81 and $148 for UBT and FAT, respectively. ICERs of UBT were 27.16 per QALY gained compared to FAT for universal retesting, making UBT a more cost-effective option than FAT in universal re-testing after a course of H. pylori eradication therapy.
CONCLUSION: Universal retesting after eradication therapy using active non-invasive tests is cost-effective compared with no re-testing providing patient benefit at minimal additional cost. Furthermore, retesting using UBT is more cost-effective than using FAT in managing patients with H. pylori infection, after adjusting for patient test compliances.
