Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori “Test and Treat” strategy for patients with suspected peptic ulcer disease?
dc.contributor.author | Rich, Melissa | en_US |
dc.contributor.author | Scheiman, James M. | en_US |
dc.contributor.author | Tierney, William M. | en_US |
dc.contributor.author | Fendrick, A. Mark | en_US |
dc.date.accessioned | 2010-06-01T20:36:56Z | |
dc.date.available | 2010-06-01T20:36:56Z | |
dc.date.issued | 2000-03 | en_US |
dc.identifier.citation | Rich, Melissa; Scheiman, James M.; Tierney, William; Fendrick, A. Mark (2000). "Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori “Test and Treat” strategy for patients with suspected peptic ulcer disease?." The American Journal of Gastroenterology 95(3): 651-658. <http://hdl.handle.net/2027.42/73722> | en_US |
dc.identifier.issn | 0002-9270 | en_US |
dc.identifier.issn | 1572-0241 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/73722 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=10710053&dopt=citation | en_US |
dc.description.abstract | Current clinical consensus supports an initial Helicobacter pylori (HP) “test and treat” approach when compared to immediate endoscopy for patients with suspected peptic ulcer disease. Alternative diagnostic approaches that incorporate upper GI radiography (UGI) have not been previously evaluated. We sought to determine the cost effectiveness of UGI compared to a HP test and treat strategy, incorporating recent data addressing the reduced prevalence of HP, lower cost of diagnostic interventions, and reduced attribution of PUD to HP. METHODS : Using decision analysis, three diagnostic and treatment strategies were evaluated: 1) Test and Treat —initial HP serology, treat patients who test positive with HP eradication and antiulcer therapy; 2) Initial UGI series —treat all patients with documented ulcer disease with HP eradication and antiulcer therapy; and 3) Initial UGI series, HP serology if ulcer present — treat ulcer and HP based on diagnostic test results. RESULTS : The estimated cost per ulcer cured for each strategy were as follows: test and treat, $3,025; initial UGI, $3,690; and UGI with serology, $3,790. The estimated cost per patient treatment were: test and treat, $498; initial UGI, $610; and UGI with serology, $620. When UGI reimbursement was decreased to less than $50, the UGI strategies yielded a lower cost per patient treated than the test and treat strategy. CONCLUSION : At the current level of reimbursement, UGI should not be considered a cost-effective alternative to the HP test and treat strategy for the initial evaluation of patients with suspected peptic ulcer disease. | en_US |
dc.format.extent | 255455 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/octet-stream | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Science Inc | en_US |
dc.rights | 2000 by Am. Coll. of Gastroenterology | en_US |
dc.title | Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori “Test and Treat” strategy for patients with suspected peptic ulcer disease? | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialties | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Division of Gastroenterology, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.contributor.affiliationum | Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan School of Medicine, Ann Arbor, Michigan, USA | en_US |
dc.identifier.pmid | 10710053 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/73722/1/j.1572-0241.2000.01837.x.pdf | |
dc.identifier.doi | 10.1111/j.1572-0241.2000.01837.x | en_US |
dc.identifier.source | The American Journal of Gastroenterology | en_US |
dc.identifier.citedreference | Talley N.J., McNeil D., Hayden A., et al. Prognosis of chronic unexplained dyspepsia. A prospective study of potential predictor variables in patients with endoscopically diagnosed nonulcer dyspepsia. Gastroenterology 1987; 92: 1060 – 1066. | en_US |
dc.identifier.citedreference | Talley N.J., Silverstein M.D., Agreus L., et al. AGA technical review. Evaluation of dyspepsia. American Gastroenterological Association. Gastroenterology 1998; 114: 582 – 595. | en_US |
dc.identifier.citedreference | Talley N.J., Weaver A.L., Tesmer D.L., et al. Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy. Gastroenterology 1993; 105: 1378 – 1386. | en_US |
dc.identifier.citedreference | Mansi C., Mela G.S., Savarino V., et al. Open access endoscopy: A large-scale analysis of its use in dyspeptic patients. J Clin Gastroenterol 1993; 16: 149 – 153. | en_US |
dc.identifier.citedreference | Laine L., Hopkins R.J., Girardi L.S. Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials. Am J Gastroenterol 1998; 93: 1409 – 1415. | en_US |
dc.identifier.citedreference | Fendrick A.M., Chernew M.E., Hirth R.A., et al. Alternative management strategies for patients with suspected peptic ulcer disease. Ann Intern Med 1995; 123: 260 – 268. | en_US |
dc.identifier.citedreference | Silverstein M.D., Petterson T., Talley N.J. Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: a decision analysis. Gastroenterology 1996; 110: 72 – 83. | en_US |
dc.identifier.citedreference | Schwartz L.M., Woloshin S., Welch H.G. Trends in diagnostic testing following a national guideline for evaluation of dyspepsia. Arch Intern Med 1996; 156: 873 – 875. | en_US |
dc.identifier.citedreference | Martin T.R., Vennes J.A., Silvis S.E., et al. A comparison of upper gastrointestinal endoscopy and radiography. J Clin Gastroenterol 1980; 2: 21 – 25. | en_US |
dc.identifier.citedreference | Shaw P.C., van Romunde L.K., Griffioen G., et al. Peptic ulcer and gastric carcinoma: Diagnosis with biphasic radiography compared with fiberoptic endoscopy. Radiology 1987; 163: 39 – 42. | en_US |
dc.identifier.citedreference | Dooley C.P., Larson A.W., Stace N.H., et al. Double-contrast barium meal, and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med 1984; 101: 538 – 545. | en_US |
dc.identifier.citedreference | Dooley C.P., Cohen H., Fitzgibbons P.L., et al. Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 1989; 321: 1562 – 1566. | en_US |
dc.identifier.citedreference | Greenberg R.E., Bank S. The prevalence of Helicobacter pylori in nonulcer dyspepsia. Importance of stratification according to age. Arch Intern Med 1990; 150: 2053 – 2055. | en_US |
dc.identifier.citedreference | Mollmann K.M., Bonnevie O., Gudbrand Hoyer E., et al. A diagnostic study of patients with upper abdominal pain. Scand J Gastroenterol 1975; 10: 805 – 809. | en_US |
dc.identifier.citedreference | Kagevi I., Lofstedt S., Persson L.G. Endoscopic findings and diagnoses in unselected dyspeptic patients at a primary health care center. Scand J Gastroenterol 1989; 24: 145 – 150. | en_US |
dc.identifier.citedreference | Jones R., Lydeard S. Prevalence of symptoms of dyspepsia in the community. Br Med J 1989; 298: 30 – 32. | en_US |
dc.identifier.citedreference | Horrocks J.C., De Dombal F.T. Clinical presentation of patients with “dyspepsia.” Detailed symptomatic study of 360 patients. Gut 1978; 19: 19 – 26. | en_US |
dc.identifier.citedreference | Fisher J.A., Surridge J.G., Vartan C.P., et al. Upper gastrointestinal endoscopy—A GP service. Br Med J 1977; 2: 1199 – 1201. | en_US |
dc.identifier.citedreference | Gear M.W., Barnes R.J. Endoscopic studies of dyspepsia in a general practice. Br Med J 1980; 280: 1136 – 1137. | en_US |
dc.identifier.citedreference | Barnes R.J., Gear M.W., Nicol A., et al. Study of dyspepsia in a general practice as assessed by endoscopy and radiology. Br Med J 1974; 4: 214 – 216. | en_US |
dc.identifier.citedreference | Colin-Jones D.G. Endoscopy or radiology for upper gastrointestinal symptoms. Lancet 1986; 1: 1022 – 1023. | en_US |
dc.identifier.citedreference | Rauws E.A., Tytgat G.N. Cure of duodenal ulcer associated with eradication of Helicobacter pylori. Lancet 1990; 335: 1233 – 1235. | en_US |
dc.identifier.citedreference | Marshall B.J., Goodwin C.S., Warren J.R., et al. Prospective double-blind trial of duodenal ulcer relapse after eradication of Campylobacter pylori. Lancet 1988; 2: 1437 – 1442. | en_US |
dc.identifier.citedreference | Evans D.J. Jr, Evans D.G., Graham D.Y., et al. A sensitive and specific serologic test for detection of Campylobacter pylori infection. Gastroenterology 1989; 96: 1004 – 1008. | en_US |
dc.identifier.citedreference | Talley N.J., Kost L., Haddad A., et al. Comparison of commercial serological tests for detection of Helicobacter pylori antibodies. J Clin Microbiol 1992; 30: 3146 – 3150. | en_US |
dc.identifier.citedreference | Cutler A.F., Havstad S., Ma C.K., et al. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology 1995; 109: 136 – 141. | en_US |
dc.identifier.citedreference | Murata H., Kawano S., Tsuji S., et al. Evaluation of the PyloriTek test for detection of Helicobacter pylori infection in cases with and without eradication therapy. Am J Gastroenterol 1998; 93: 2102 – 2105. | en_US |
dc.identifier.citedreference | Bayerdorffer E., Miehlke S., Mannes G.A., et al. Double-blind trial of omeprazole, and amoxicillin to cure Helicobacter pylori infection in patients with duodenal ulcers. Gastroenterology 1995; 108: 1412 – 1417. | en_US |
dc.identifier.citedreference | Chiba N., Rao B.V., Rademaker J.W., et al. Meta-analysis of the efficacy of antibiotic therapy in eradicating Helicobacter pylori. Am J Gastroenterol 1992; 87: 1716 – 1727. | en_US |
dc.identifier.citedreference | Coelho L.G., Passos M.C., Chausson Y., et al. Five-day bismuth-free triple therapy for the eradication of Helicobacter pylori and reduction of duodenal ulcer relapse. Am J Gastroenterol 1991; 86: 971 – 975. | en_US |
dc.identifier.citedreference | Hentschel E., Brandstatter G., Dragosics B., et al. Effect of ranitidine and amoxicillin plus metronidazole on the eradication of Helicobacter pylori and the recurrence of duodenal ulcer. N Engl J Med 1993; 328: 308 – 312. | en_US |
dc.identifier.citedreference | Hosking S.W., Ling T.K., Yung M.Y., et al. Randomised controlled trial of short term treatment to eradicate Helicobacter pylori in patients with duodenal ulcer. Br Med J 1992; 305: 502 – 504. | en_US |
dc.identifier.citedreference | Labenz J., Gyenes E., Ruhl G.H., et al. Amoxicillin plus omeprazole versus triple therapy for eradication of Helicobacter pylori in duodenal ulcer disease: A prospective, randomized, and controlled study. Gut 1993; 34: 1167 – 1170. | en_US |
dc.identifier.citedreference | Labenz J., Gyenes E., Ruhl G.H., et al. Omeprazole plus amoxicillin: Efficacy of various treatment regimens to eradicate Helicobacter pylori. Am J Gastroenterol 1993; 88: 491 – 495. | en_US |
dc.identifier.citedreference | Logan R.P., Gummett P.A., Hegarty B.T., et al. Clarithromycin and omeprazole for Helicobacter pylori. Lancet 1992; 340: 239 ( letter ). | en_US |
dc.identifier.citedreference | Thijs J.C., Van Zwet A.A., Oey H.B. Efficacy and side effects of a triple drug regimen for the eradication of Helicobacter pylori. Scand J Gastroenterol 1993; 28: 934 – 938. | en_US |
dc.identifier.citedreference | Peterson W.L., Graham D.Y., Marshall B., et al. Clarithromycin as monotherapy for eradication of Helicobacter pylori: a randomized, double-blind trial. Am J Gastroenterol 1993; 88: 1860 – 1864. | en_US |
dc.identifier.citedreference | Bell G.D., Powell K., Burridge S.M., et al. Experience with “triple” anti-Helicobacter pylori eradication therapy. side effects and the importance of testing the pre-treatment bacterial isolate for metronidazole resistance. Aliment Pharmacol Therapeut 1992; 6: 427 – 435. | en_US |
dc.identifier.citedreference | Farup P.G. Compliance with anti-ulcer medication during short-term healing phase clinical trials. Aliment Pharmacol Therapeut 1992; 6: 179 – 186. | en_US |
dc.identifier.citedreference | Malfertheiner P. Compliance, adverse events and antibiotic resistance in Helicobacter pylori treatment. Scand J Gastroenterol 1993; 196 ( suppl ): 34 – 37. | en_US |
dc.identifier.citedreference | Bamberg P., Caswell C.M., Frame M.H., et al. A meta-analysis comparing the efficacy of omeprazole with H2-receptor antagonists for acute treatment of duodenal ulcer in Asian patients. J Gastroenterol Hepatol 1992; 7: 577 – 585. | en_US |
dc.identifier.citedreference | Graham D.Y., McCullough A., Sklar M., et al. Omeprazole versus placebo in duodenal ulcer healing. The United States experience. Dig Dis Sci 1990; 35: 66 – 72. | en_US |
dc.identifier.citedreference | Bardhan K.D., Bianchi Porro G., Bose K., et al. A comparision of two different doses of omeprazole versus ranitidine in treatment of duodenal ulcers. J Clin Gastroenterol 1989; 21: 408 – 413. | en_US |
dc.identifier.citedreference | Abu-Mahfouz M.Z., Prasad V.M., Santogade P., et al. Helicobacter pylori recurrence after successful eradication: 5-year follow-up in the United States. Am J Gastroenterol 1997; 92: 2025 – 2028. | en_US |
dc.identifier.citedreference | Archambult A.P., Pare P., Bailey R.J., et al. Omeprazole (20 mg daily) versus cimetidine (1200 mg daily) in duodenal ulcer healing, and pain relief. Gastroenterology 1988; 94: 1130 – 1134. | en_US |
dc.identifier.citedreference | Graham D.Y., Colon-Pagan J., Morse R.S., et al. Ulcer recurrence following duodenal ulcer healing with omeprazole, ranitidine, or placebo: A double-blind, multicenter, 6-month study. The Omeprazole Duodenal Ulcer Study Group. Gastroenterology 1992; 102: 1289 – 1294. | en_US |
dc.identifier.citedreference | Dobrilla G., Vallaperta P., Amplatz S. Influence of ulcer healing agents on ulcer relapse after discontinuation of acute treatment: a pooled estimate of controlled clinical trials. Gut 1988; 29: 181 – 187. | en_US |
dc.identifier.citedreference | Elashoff J.D., Van Deventer G., Reedy T.J., et al. Long-term follow-up of duodenal ulcer patients. J Clin Gastroenterol 1983; 5: 509 – 515. | en_US |
dc.identifier.citedreference | Glise H., Carling L., Hallerbaeck B., et al. Relapse rate of healed duodenal, prepyloric, and gastric ulcers treated either with sucralfate or cimetidine. Am J Med 1987; 83: 105 – 109. | en_US |
dc.identifier.citedreference | Lane M.R., Lee S.P. Recurrence of duodenal ulcer after medical treatment. Lancet 1988; 1: 1147 – 1149. | en_US |
dc.identifier.citedreference | Van Deventer G.M., Elashoff J.D., Reedy T.J., et al. A randomized study of maintenance therapy with ranitidine to prevent the recurrence of duodenal ulcer. N Engl J Med 1989; 320: 1113 – 1119. | en_US |
dc.identifier.citedreference | Bank S., Chow K., Greenberg R. Helicobacter pylori and recurrence of duodenal ulcers. Am J Gastroenterol 1992; 87: 1365 – 1367. | en_US |
dc.identifier.citedreference | Forbes G.M., Glaser M.E., Cullen D.J., et al. Duodenal ulcer treated with Helicobacter pylori eradication: seven-year follow-up. Lancet 1994; 343: 258 – 260. | en_US |
dc.identifier.citedreference | Borody T.J., Cole P., Noonan S., et al. Recurrence of duodenal ulcer and Campylobacter pylori infection after eradication. Med J Australia 1989; 151: 431 – 435. | en_US |
dc.identifier.citedreference | Coghlan J.G., Gilligan D., Humphries H., et al. Campylobacter pylori and recurrence of duodenal ulcers—A 12-month follow-up study. Lancet 1987; 2: 1109 – 1111. | en_US |
dc.identifier.citedreference | Patchett S., Beattie S., Leen E., et al. Eradicating Helicobacter pylori and symptoms of non-ulcer dyspepsia. Br Med J 1991; 303: 1238 – 1240. | en_US |
dc.identifier.citedreference | Bytzer P., Hansen J.M., Schaffalitzky de Muckadell O.B. Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia. Lancet 1994; 343: 811 – 816. | en_US |
dc.identifier.citedreference | 58. Anonymous. Endoscopy in the evaluation of dyspepsia. Health, and Public Policy Committee, American College of Physicians. Ann Intern Med 1985; 102: 266 – 9. | en_US |
dc.identifier.citedreference | 59. Anonymous. NIH Consensus Conference. Helicobacter pylori in peptic ulcer disease. NIH Consensus Development Panel on Helicobacter pylori in Peptic Ulcer Disease. JAMA 1994; 272: 65 – 9. | en_US |
dc.identifier.citedreference | Hirth R.A., Bloom B.S., Chernew M.E., et al. Willingness to pay for diagnostic certainty. J Gen Intern Med 1999; 14: 193 – 195. | en_US |
dc.identifier.citedreference | Goodson J.D., Lehmann J.W., Richter J.M., et al. Is upper gastrointestinal radiography necessary in the initial management of uncomplicated dyspepsia? A randomized controlled trial comparing empiric antacid therapy plus patient reassurance with traditional care. J Gen Intern Med 1989; 4: 367 – 374. | en_US |
dc.identifier.citedreference | Ling T.K., Cheng A.F., Sung J.J., et al. An increase in Helicobacter pylori strains resistant to metronidazole: A five-year study. Helicobacter 1996; 1: 57 – 61. | en_US |
dc.identifier.citedreference | Vakil N., Hahn B., McSorley D. Clarithromycin-resistant Helicobacter pylori in patients with duodenal ulcer in the United States. Am J Gastroenterol 1998; 93: 1432 – 1435. | en_US |
dc.identifier.citedreference | Fendrick A.M., Chernew M.E., Hirth R.A., et al. Clinical and economic effects of population-based Helicobacter pylori screening to prevent gastric cancer. Arch Intern Med 1999; 159: 142 – 148. | en_US |
dc.identifier.citedreference | Nomura A., Stemmermann G., Chyou P.H., et al. Helicobacter pylori infection and the risk for duodenal and gastric ulceration. Ann Intern Med 1994; 120: 977 – 981. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
Files in this item
Remediation of Harmful Language
The University of Michigan Library aims to describe library materials in a way that respects the people and communities who create, use, and are represented in our collections. Report harmful or offensive language in catalog records, finding aids, or elsewhere in our collections anonymously through our metadata feedback form. More information at Remediation of Harmful Language.
Accessibility
If you are unable to use this file in its current format, please select the Contact Us link and we can modify it to make it more accessible to you.