Omata Fumio, Shimbo Takuro, Ohde Sachiko, Deshpande Gautam A, Fukui Tsuguya
Department of Internal Medicine, St. Luke's International Hospital, Chuo-Ku, Japan; Center for Clinical Epidemiology, St. Luke's International University, Chuo-Ku, Japan.
Ohta Nishinouchi Hospital, Koriyama, Japan.
Gastroenterol Res Pract. 2017;2017:2453254. doi: 10.1155/2017/2453254. Epub 2017 Feb 23.
. There are several diagnostic methods for infection. A cost-effective analysis is needed to decide on the optimal diagnostic method. The aim of this study was to determine a cost-effective diagnostic method in patients with atrophic gastritis (AG). . A decision-analysis model including seven diagnostic methods was constructed for patients with AG diagnosed by esophagogastroduodenoscopy. Expected values of cost and effectiveness were calculated for each test. . If the prevalence of in the patients with AG is 85% and CAM-resistant is 30%, histology, stool antigen (SHPAg), bacterial culture (BC), and urine antibody (UHPAb) were dominated by serum IgG antibody (SHPAb), rapid urease test (RUT), and urea breath test (UBT). Among three undominated methods, the incremental cost-effective ratios (ICER) of RUT versus SHPAb and UBT versus RUT were $214 and $1914, respectively. If the prevalence of CAM-sensitive was less than 55%, BC was not dominated, but its eradication success rate was 0.86. . RUT was the most cost-effective at the current prevalence of CAM-resistant . BC could not be selected due to its poor effectiveness even if CAM-resistant was more than 45%.
感染有多种诊断方法。需要进行成本效益分析以确定最佳诊断方法。本研究的目的是确定萎缩性胃炎（AG）患者的成本效益诊断方法。为经食管胃十二指肠镜诊断为AG的患者构建了一个包含七种诊断方法的决策分析模型。计算了每种检测的成本和效果期望值。如果AG患者中幽门螺杆菌（Hp）的患病率为85%且对克拉霉素耐药的Hp为30%，则组织学、粪便Hp抗原（SHPAg）、细菌培养（BC）和尿液Hp抗体（UHPAb）被血清Hp IgG抗体（SHPAb）、快速尿素酶试验（RUT）和尿素呼气试验（UBT）所主导。在三种非主导方法中，RUT与SHPAb以及UBT与RUT的增量成本效益比（ICER）分别为214美元和1914美元。如果对克拉霉素敏感的Hp患病率低于55%，BC不被主导，但其根除成功率为0.86。在当前对克拉霉素耐药的Hp患病率下，RUT是最具成本效益的。即使对克拉霉素耐药的Hp超过45%，由于其效果不佳，也不能选择BC。
