Abstract
Objective
Previous US-based economic models of noninvasive tests for diagnosis of Helicobacter pylori infection did not consider patient adherence or downstream costs of continuing infection. This analysis evaluated the long-term cost-effectiveness of the urea breath test (UBT), fecal antigen test (FAT), and serology for diagnosis of H. pylori infection after incorporating information regarding test adherence.
Materials and methods
A decision-analytic model incorporating adherence information evaluated the cost-effectiveness of the UBT, FAT, and serology for diagnosis of H. pylori infection. Positive test results led to first-line triple therapy; no further action was taken for nonadherence or negative results. Excess lifetime costs and reduced quality-adjusted life-years (QALYs) were estimated for patients with continuing H. pylori infection.
Results
In the base-case scenario with estimated adherence rates of 86%, 48%, and 86% for the UBT, monoclonal FAT, and serology, respectively, corresponding expected total costs were US$424.99, $466.41, and $404.98/patient. Test costs were higher for the UBT, but were fully or partially offset by higher excess lifetime costs for the monoclonal FAT and serology. The QALYs gained/patient with the UBT vs monoclonal FAT and serology were 0.86 and 0.27, respectively. The UBT was dominant vs the monoclonal FAT, leading to lower costs and higher QALYs; the UBT was cost-effective vs serology (incremental cost/QALY gained $74).
Conclusion
Based on a comprehensive modeled analysis that included consideration of patient test adherence and long-term consequences resulting from continuing H. pylori infection, the UBT provided the greatest economic value among noninvasive tests for diagnosis of H. pylori infection, because of high patient adherence and excellent test performance.
Supplementary material
Table S1 Estimation of excess lifetime costs associated with peptic ulcer disease
Acknowledgments
This research was fully funded by Otsuka America Pharmaceutical Inc. Editorial assistance was provided by Catherine Fontana, Geoff Marx, and Barry M Weichman, PhD of BioScience Communications, New York, and was funded by Otsuka. The abstract of this manuscript was presented as a poster presentation at the 79th annual scientific meeting of American College of Gastroenterology, in 2014. The poster abstract was published in The American Journal of Gastroenterology; 2014;109(2):s661. http://www.nature.com/ajg/journal/v109/n2s/pdf/ajg2014280a.pdf.
Disclosure
SHB is a former employee of Otsuka. AWM, VR, and DM are employees of RTI, which was contracted by Otsuka to conduct this study. TW is an employee of Otsuka. The authors report no other conflicts of interest in this work.