Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori "test and treat" strategy for patients with suspected peptic ulcer disease?

OBJECTIVE: Current clinical consensus supports an initial Helicobacter pylo ri (HP) "test and treat" approach when compared to immediate endoscopy for patients with suspected peptic ulcer disease. Alternative diagnostic approa ches that incorporate upper GI radiography (UGI) have not been previously e valuated. We sought to determine the cost effectiveness of UGI compared to a HP test and treat strategy, incorporating recent data addressing the redu ced prevalence of HP, lower cost of diagnostic interventions, and reduced a ttribution of PUD to HP. METHODS: Using decision analysis, three diagnostic and treatment strategies were evaluated: 1) Test and Treat-initial HP serology, treat patients who test positive with HP eradication and antiulcer therapy; 2) Initial UGI ser ies-treat all patients with documented ulcer disease with HP eradication an d antiulcer therapy; and 3) Initial UGI series, HP serology if ulcer presen t-treat ulcer and HP based on diagnostic test results. RESULTS: The estimated cost per ulcer cured for each strategy were as follo ws: test and treat, $3,025; initial UGI,$3,690; and UGI with serology, $3,7 90. The estimated cost per patient treatment were: test and treat, $498; in itial UGI, $610; and UGI with serology, $620. When UGI reimburse ment was d ecreased to less than $50, the UGI strategies yielded a lower cost per pati ent treated than the test and treat strategy. CONCLUSION: At the current level of reimbursement, UGI should not be consid ered a cost-effective alternative to the HP test and treat strategy for the initial evaluation of patients with suspected peptic ulcer disease. (Am J Gastroenterol 2000;95:651-658. (C) 2000 by Am. Coll. of Gastroenterology).