Noninvasive Helicobacter pylori testing for the "test-and-treat" strategy - A decision analysis to assess the effect of past infection on test choice

Background: Clinical guidelines support a noninvasive Helicobacter pylori " test-and-treat" strategy for individuals with uncomplicated dyspepsia. Howe ver, consensus is lacking regarding the preferred noninvasive testing metho d. objective: To use decision analytic modeling to estimate the clinical and e conomic outcomes associated with noninvasive tests designed to detect eithe r H pylori antibody or active H pylori infection. Design: Decision analytic model. Patients: A simulated patient cohort with uncomplicated dyspepsia. Interventions: The simulated dyspepsia cohort underwent antibody testing or testing to detect active H pylori infection (active testing). individuals testing positive received eradication therapy. Main Outcome Measures: Appropriate and inappropriate treatment prescribed, cost per patient treated, incremental cost per unnecessary treatment avoide d. Results: Active testing led to a substantial reduction in unnecessary treat ment for patients without active infection (antibody, 23.7; active, 1.4 per 100 patients) at an incremental cost of $37 per patient. The clinical adva ntage and cost-effectiveness of active testing was enhanced as the percenta ge of individuals with a positive antibody test result from past, but not c urrent, infection increased. Conclusions: Active testing for H pylori infection significantly decreases the inappropriate use of antimicrobial therapy when compared with antibody testing. The advantages of active testing should be enhanced as the widespr ead use of antimicrobial agents increases the proportion of patients with a ntibody to H pylori, but without active infection.