Current standards for establishing a cure of Helicobacter pylori infection require 2 breath tests taken at least 4 weeks apart, to be negative.
Professor Berardino Vaira and colleagues from Italy determined the incremental cost and accuracy of repeating a urea breath test in clinical practice.
|The cost of a second breath test was 12,570 euros|
|Alimentary Pharmacology & Therapeutics|
The research team identified 419 patients with documented Helicobacter pylori infection who received eradication therapy, and then had 2 breath tests.
The first breath test occurred at 4 weeks, and the second at least 8 weeks after the completion of treatment.
Helicobacter pylori infection was documented at baseline by a positive rapid urease test and histology.
In 317 patients with successful eradication of H. pylori infection, the mean delta over baseline value before treatment was 43 ppm.
Following treatment, the mean delta over baseline value in cured patients was 0.6 ppm at 1 month.
The research team noted that the mean delta over baseline value at 1months was similar to the value obtained at the second breath, which was performed 60 days after the first breath test.
In 102 patients remaining infected, the mean delta over baseline value at baseline was 47 ppm.
The researchers observed that at 4 weeks after treatment, the delta over baseline value was 40 ppm.
The second breath test was performed 94 days after the first, and the delta over baseline value was significantly greater than the first.
There was no discordant result between the first breath test and second breath test.
At a cost of 30 euros/breath test, the incremental cost of a second breath test was 12,570 euros in this cohort with no incremental clinical benefit.
Professor Vaira’s team concludes, “A single urease breath test, 4 weeks after treatment is as effective as 2 serial breath tests in confirming H. pylori eradication.”
“The incremental cost of the second breath test is very high with no incremental clinical benefit.”