Test and treat strategies for Helicobacter pylori in uninvestigated dyspepsia: A Canadian economic analysis.

BACKGROUND: Recognition of the pivotal role of Helicobacter pylori in the p athogenesis of peptic ulcer disease has revolutionized primary care approac hes to dyspepsia. Decision analysis was used to compare the cost effectiven ess of empirical ranitidine with a test and treat strategy using either H p ylori serology or the (13)carbon-urea breath test (C-13-UBT). PATIENTS AND METHODS: A cohort of patients under age 50 pears presenting wi th uninvestigated dyspepsia was evaluated. Three initial strategies were co mpared with respect to direct medical costs and effectiveness in curing H p ylori-related ulcers - empirical ranitidine, H pylori serology and UBT. A o ne-year time horizon and third-party payer perspective were adopted in a Ca nadian health care setting. RESULTS: UBT was more costly than either serology or ranitidine but a as th e most effective strategy and required the fewest endoscopies. No strategy demonstrated dominance over another in the base case. The incremental cost effectiveness ratio (ICER) of serology versus ranitidine was $118/cure, and sensitivity analysis induced dominance of serology in several plausible sc enarios. The baseline ICER of UBT versus serology was $885/cure but showed substantial variation in sensitivity analysis. Each ICER was highly sensiti ve to variation in the cost of the tests themselves. At a serology cost of $25, UBT became dominant when its cost fell to $39. CONCLUSIONS: In low risk patients with uninvestigated dyspepsia, testing fo r H pylori using serology appears to be economically attractive. C-13-UBT m ay be a cost effective alternative to serology if local conditions closely approximate the model parameters. Future changes in the costs of serology a nd C-13-UBT may determine the optimal approach.