Cost-Effectiveness Analysis of Helicobacter pylori Diagnostic Methods in Patients with Atrophic Gastritis

Table 1

Probabilities and costs.

Variable	Base case	References	Range for one-way; sensitivity analysis	Range in Monte; Carlo analysis
Probabilities
Prevalence of H. pylori in AG	0.85	[11]	0.2–0.9	0.2–0.9
Proportion of CAM-resistant H. pylori	0.3	[37]	0.1–0.7	n. a.
Sensitivity
Bacterial culture	0.87	[22]	n. a.	0.77–0.97
Rapid urease test	0.94	[22]	n. a.	0.84–1
Histology	0.96	[22]	n. a.	0.86–1
UBT	0.96	[23]	n. a.	0.86–1
Serum H. pylori IgG antibody	0.85	[24]	n. a.	0.75–0.95
Stool H. pylori antigen	0.93	[25]	n. a.	0.83–1
Urine H. pylori antibody	0.87	[26–36]	n. a.	0.77–0.97
Specificity
Bacterial culture	0.96	[22]	n. a.	0.86–1
Rapid urease test	0.91	[22]	n. a.	0.81–1
Histology	0.77	[22]	n. a.	0.67–0.87
UBT	0.93	[23]	n. a.	0.83–1
Serum H. pylori IgG antibody	0.79	[24]	n. a.	0.69–0.89
Stool H. pylori antigen	0.96	[25]	n. a.	0.86–1
Urine H. pylori antibody	0.94	[26–36]	n. a.	0.84–1
Success rate of eradication regimens
Success rate of 1st regimen for all	0.76	[12]	0.6–0.9	0.66–0.86
Success rate of 1st regimen for; CAM-sensitive H. pylori	0.92	[13]	n. a.	0.82–1
Success rate of 1st regimen for; CAM-resistant H. pylori	0.2	[14, 15]	n. a.	0.1–0.3
Success rate of 2nd regimen for; CAM-resistant H. pylori	1	[15]	n. a.	0.9–1
Success rate of 2nd regimen for; CAM-sensitive H. pylori after 1st; regimen failure	0.9	[16]	n. a.	0.8–1
Success rate of 2nd regimen for; CAM-resistant H. pylori after 1st; regimen failure	0.9	[16]	n. a.	0.8–1
Success rate of 3rd regimen for; CAM-sensitive H. pylori after; 1st and 2nd regimen	0.67	[17]	n. a.	0.57–0.77
Success rate of 3rd regimen for; CAM-resistant H. pylori after; 1st and 2nd regimen	0.73	[17]	n. a.	0.63–0.83
Costs
Diagnostics costs
Bacterial culture with antibiotics; sensitivity during EGD	$62	[18]	n. a.	n. a.
Bacterial culture only during EGD	$45	[18]	n. a.	n. a.
Rapid urease test during EGD	$20	[18]	n. a.	n. a.
Histology including; immunohistochemistry during EGD	$234	[18]	n. a.	n. a.
UBT	$53	[18]	n. a.	n. a.
Serum H. pylori IgG antibody	$14	[18]	n. a.	n. a.
Stool H. pylori antigen	$33	[18]	n. a.	n. a.
Urine H. pylori antibody	$25	[18]	n. a.	n. a.
Antibiotics and administration costs
LAC for one week (1st line)	$45	[21]	n. a.	n. a.
LAM for one week (2nd line)	$35	[21]	n. a.	n. a.
LAS for one week (3rd line)	$92	[21]	n. a.	n. a.

H. pylori, Helicobacter pylori; AG, atrophic gastritis; CAM, clarithromycin, UBT, urea breath test; EGD, esophagogastroduodenoscopy; LAC, lansoprazole 30 mg bid, amoxicillin 750 mg bid, and clarithromycin 200 mg bid; LAM, lansoprazole 30 mg bid, amoxicillin 750 mg bid, and metronidazole 500 mg bid; LAS, lansoprazole 30 mg bid, amoxicillin 500 mg bid, and sitafloxacin 100 mg bid; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection; n. a., not applicable.
^*This range was not used in Monte Carlo analysis but in one-way sensitivity analysis.