Boklage SH, Mangel AW, Ramamohan V, Mladsi DM, Wang T. Effects of patient compliance on the cost-effectiveness of non-invasive tests for initial diagnosis of H. pylori infection in a high prevalence population. Poster presented at the 79th Annual Scientific Meeting of the American College of Gastroenterology; October 17, 2014. Philadelphia, PA.

Purpose: Although the cost-effectiveness of various H. pylori test options has been published, none of the previous models incorporated patient preference and compliance in the analysis. The objectives of this study were to evaluate the cost-effectiveness of urea breath tests (UBT), fecal antigen tests (FAT) and serologic tests (SAT) for initial diagnosis of H. pylori infection in a population with a relatively high prevalence of H. pylori infection (37% in the model compared to 22% among people born in the United States).

Methods: A decision-tree model was developed to evaluate the cost-effectiveness of UBT, FAT and SAT in initial diagnosis of H. pylori infection incorporating patient compliance. Patient compliance information was collected from the literature. A positive test resulted in first-line treatment; no further action in the model was taken for patients noncompliant with testing or for patients testing negative. With continued H. pylori infection due to noncompliance to testing, false negative test results, or treatment failure, excess lifetime costs (LTC) and reduced quality-adjusted life-years (QALYs) per patient, estimated with respect to patients without H. pylori infection, were incurred.

Results: In the base-case scenario, in which the estimated patient compliance rates were 86%, 48% and 86% for UBT, FAT and SAT, respectively, the calculated total costs per patient were $424 for UBT, $465 for FAT and $404 for SAT. Costs of managing dyspepsia, peptic ulcer and gastric cancer in patients still having H. pylori infection accounted for the majority of the difference in total costs between UBT and FAT, more than offsetting the difference in the costs of the tests. Between UBT and SAT, this difference offset more than half the difference in the test costs. Reduced QALYs relative to patients with continuing H. pylori infection were estimated as 0.78, 1.63 and 1.05 for the UBT, FAT and SAT respectively. UBT was the most cost-effective option with an estimated incremental cost per QALY gained of -$47.59 and $74.88 compared to FAT and SAT, respectively. Test performance (i.e., clinical sensitivity and specificity) and patient compliance were important determinants of the cost-effectiveness in management of H. pylori infection.

Conclusion: UBT is the most cost-effective non-invasive test for initial diagnosis of H. pylori infection as part of the overall management of H. pylori infection in high prevalence populations after adjusting for patient compliance.

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