Diagnosis of Helicobacter pylori after triple therapy in uncomplicated duodenal ulcers - a cost-effectiveness analysis

Background: The cost-effectiveness of determining Helicobacter pylori statu s after treatment remains to be established. Aim: To determine the benefit of post-treatment assessment of H. pylori era dication in patients with uncomplicated duodenal ulcer. Materials and methods: A decision analysis was performed in patients with u ncomplicated duodenal ulcer who were H. pylori-positive and had received er adication therapy. A decision tree was devised to compare the costs per pat ient of two different strategies: (a) systematic performance of post-treatm ent urea breath test and new treatment if positive; and (b) clinical follow -up, C-13-urea breath test if dyspeptic symptoms recurred and eradication t reatment if the test was positive. Results: Post-eradication C-13-urea breath test was notably more expensive than clinical follow-up, both in a low-cost per care setting (197 vs. 132 E uros) and in a high-cost per care (614 vs. 340 US $) scenario. This conclus ion remained stable for a wide range of variations of the variables include d in the decision tree (e.g. cure rates of eradication treatment, cost of t he urea breath test or sensitivity, and specificity of urea breath test to detect eradication). Conclusion: In patients with uncomplicated duodenal ulcer, evaluation of er adication after H. pylori treatment markedly increases costs with no clear improvement in results and therefore should not be performed routinely.