在接受内镜检查的患有出血性胃潰瘍的患者中,用于Helicobacter Pylori的初始诊断策略:成本效益分析
Michael G Artin1, Josephine Soddano1, Sheila D Rustgi2
1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Gastro hep advances
|February 25, 2025
概括
尿素呼吸试验 (UBT) 是最具成本效益的策略,用于识别Helicobacter pylori在患有出血性胃潰瘍住院的患者,降低成本和住院.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 卫生经济学 卫生经济学
背景情况:
- 杆菌 (H. pylori) 感染是导致胃潰瘍疾病 (PUD) 和上胃肠道出血的首要原因.
- 根除H. pylori显著降低了PUD并发症的风险,包括反复出现的胃肠道出血.
- 有效的H. pylori检测策略对于治疗出血性PUD的患者至关重要.
研究的目的:
- 确定最具成本效益的策略,在患有出血性胃潰瘍的住院患者中进行H. pylori测试.
- 为了比较六种不同的H. pylori检测方法的经济和临床结果.
- 在这个患者群体中为H. pylori查提供临床指南的信息.
主要方法:
- 使用马尔科夫队列模型来模拟和比较六种H. pylori测试策略:没有测试,组织学,快速尿素酶测试,便抗原测试,尿素呼吸测试 (UBT) 和血清学.
- 该模型纳入了17%的H. pylori患病率在患有出血的患者中.
- 评估的关键结果包括因出血而重新住院,预期寿命,总成本,质量调整后生命年 (QALY) 和增量成本效益比率 (ICER).
主要成果:
- 尿素呼吸测试 (UBT) 成为首选的策略,与没有测试相比,它显示出更高的成本效益.
- UBT的结果是,每名患者平均获得0.02个QALY,并且节省了2140美元的成本.
- 实施UBT可以防止每年每10,000名患者大约有1675例住院治疗,需要治疗的患者数为167人,以避免在35年内增加一次住院治疗.
结论:
- 尿素呼吸试验 (UBT) 是诊断H. pylori在患有出血性胃的住院患者中最具成本效益的方法.
- 非侵入性H. pylori检测,如UBT,应在护理点或住院期间考虑.
- 实施UBT提供了潜在的临床益处和有限的患者风险,改善了PUD管理的结果.
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