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Helicobacter pylori in New Zealand: current diagnostic trends and related costs
Jan Kubovy1, Murray L Barclay2
1Consultant Gastroenterologist, Department of Gastroenterology, Christchurch Hospital, Christchurch, New Zealand.
Aim:
To ascertain Helicobacter pylori (Hp) diagnosis trends and cost in a New Zealand cohort.
Methods:
All Hp tests within Canterbury between 2013-2018 were retrospectively reviewed, exclusive of histology. Overall numbers for each test modality, expenditure and test positivity rates were calculated and matched to ethnicity.
Results:
Over the six-year period, Hp testing increased 37% and associated cost by 42.6%, compared with population growth of 11.1%. Primary care requested 82% of the non-invasive tests. Despite guidelines recommending against Hp serology, this was the most frequent test and duplicate testing in the same patient was common. Mean annual test positivity rates were: Hp serology 12.3%; Campylobacter-like organism 7.2%; Hp stool antigen test 10.2%; urea breath test 17.5%. The mean across all test modalities was 10.4%. Test proportion per ethnicity was lower in Māori (48.2%) and Pasifika (67.8%), compared with Europeans (82.7%). This was in contrast with significantly higher test positivity rates (Māori 21.2%, Pasifika 37.8%) compared with Europeans 8.4%.
Conclusion:
Hp testing and related costs increase is disproportionate to population growth. At risk ethnicities are under-represented in the tested cohort despite higher test positivity rates. Primary care-focussed intervention could lead to reduced cost and improved equity in Hp diagnosis.
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