Which test is best for Helicobacter pylori? A cost-effectiveness model using decision analysis

Area of Science:

• Gastroenterology
• Health Services Research
• Diagnostic Accuracy

Background:

• General practitioners (GPs) require effective methods for Helicobacter pylori detection in dyspeptic patients.
• National Institute for Health and Clinical Excellence (NICE) guidelines recommend a 'test and treat' approach before gastroscopy.
• Current diagnostic options include serology, urea breath test, and faecal antigen test, with no preferred method specified by NICE.

Purpose of the Study:

• To conduct a cost-effectiveness analysis of available Helicobacter pylori diagnostic tests.
• To determine the most practical and cost-effective H. pylori test for primary care settings.
• To inform the development of optimal diagnostic pathways for H. pylori in primary care.

Main Methods:

• A multi-stakeholder workshop convened to develop a cost-effectiveness decision analysis model.
• Agreement reached on costs and diagnostic values for serology, urea breath test, and faecal antigen test.
• Simulation of 1000 virtual patients for each diagnostic strategy.

Main Results:

• The faecal antigen test demonstrated the highest true positive outcomes (968/1000).
• Serology yielded 903 true positive outcomes, and the urea breath test yielded 961.
• The faecal antigen test was identified as the most effective and cost-effective strategy.

Conclusions:

• The faecal antigen test is the preferable strategy for H. pylori diagnosis in primary care.
• Findings have implications for implementing new testing processes and commissioning diagnostic pathways.
• Optimizing H. pylori testing can improve patient outcomes and resource allocation in primary care.