Helicobacter pylori screening for individuals requiring chronic NSAID therapy: a decision analysis

Introduction: Although it is incontrovertible that Helicobacter pylori caus es peptic ulcer disease, controversy persists regarding the impact of H. py lori infection on the incidence of NSAID-related complications and whether H. pylori eradication reduces the rate of adverse events. Methods: A symptom-driven decision analytic model was developed to compare the clinical and economic impact of H. pylori screening compared to a strat egy of no H. pylori testing for individuals requiring chronic NSAID therapy . In the principal analysis, it was assumed that untreated H. pylori infect ion increased the ulcer risk by 50% and that successful eradication reduced the risk of adverse events to that of uninfected patients. Patients' ulcer risk and the protective effect of H. pylori eradication were evaluated usi ng sensitivity analysis. Results: When compared to no H. pylori testing, H. pylori screening led to fewer symptomatic ulcers (no test, 5.4; H. pylori test, 4.6 per 100 patient years) and ulcer complications (no test, 2.6; H. pylori test, 2.3 per 100 patient years) and a higher cost per patient (no test, $435; H. pylori test , $556). The incremental cost attributable to the H. pylori screening strat egy to prevent a symptomatic and complicated ulcer was $16 805 and $31 842, respectively. The clinical and cost-effectiveness advantage of H. pylori s creening improved as patients' ulcer risk increased or the protective effec t of H. pylori eradication was enhanced. Conclusions: Based upon the available evidence, H. pylori screening has the potential to reduce NSAID-related adverse events for average-risk patients at an incremental cost. Until controlled investigations definitively quant ify the effect of H. pylori eradication on clinically significant NSAID-rel ated adverse events, a compelling argument can be made for H. pylori testin g for chronic NSAID users at increased risk of ulcer disease.