The role of endoscopic biopsies in the detection of Helicobacter pylori in patients with non-ulcer dyspepsia is not clear.
In this study, researchers from Canada and Europe assessed the cost-effectiveness of performing routine biopsies to detect H. pylori at upper endoscopy.
The team based their clinical decision-making on outcomes data from published articles and expert opinion.
They evaluated adults (< 45 years) with non-ulcer dyspepsia defined by a normal endoscopy.
|Endoscopy with biopsy and rapid urease testing costs $3940 per additional symptom-free patient.|
Costs, expressed in Canadian dollars, were tabulated over a 1-year time period.
The main outcome measured by the team was relief of symptoms. This was defined as the absence of symptom persistence or recurrence over the 12 months.
The researchers compared performing a biopsy for the detection of H. pylori with a rapid urease test during gastroscopy, with that of not performing a biopsy.
They also performed a secondary analysis, where they evaluated the cost-effectiveness of obtaining a biopsy specimen for histopathologic evaluation in patients after a negative rapid urease test.
The researchers found that endoscopy with biopsy and rapid urease testing costs $3940 per additional symptom-free patient, compared with endoscopy without biopsy.
However, they determined that this result was sensitive to the difference in symptomatic recurrence rate at 1 year, in patients in whom H. pylori eradication was successful and unsuccessful. The team set this rate at 10%.
Only when the difference in symptomatic recurrence in these patients fell to less than 4% was endoscopy with biopsy over $10,000 per cured patient greater than endoscopy without biopsy.
The team identified little additional benefit associated with histopathologic assessment of biopsy specimens in patients with a negative rapid urease test. Cost per additional cure was $25,529.
Dr Nicholaos Makris's team concluded, "In adults with non-ulcer dyspepsia under age 45 years undergoing endoscopy, routine procurement of a biopsy specimen for detection of H. pylori was more costly yet more effective compared with not obtaining a specimen".
"The cost-effectiveness of a biopsy is dependent on the benefits of H. pylori eradication in this patient population".
"The less likely a patient with non-ulcer dyspepsia is to become asymptomatic after successful H. pylori eradication, the more costly a strategy of routinely obtaining a specimen at endoscopy".
"The additional cost of sending a specimen for histopathologic analysis if the rapid urease test is negative does not appear warranted based on cost-effectiveness considerations".