Cost-benefit analysis of testing for Helicobacter pylori in dyspeptic subjects.
Cost-benefit analysis of testing for Helicobacter pylori in dyspeptic subjects.
复制标题
消化不良受试者幽门螺杆菌检测的成本效益分析。
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
A. Sonnenberg
中科院分区：
文献类型：
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作者：
A. Sonnenberg
目标
如何管理出现消化不良症状的患者仍然存在争议。是否所有消化不良患者都应接受放射学或内窥镜检查以诊断消化性溃疡，或者幽门螺杆菌血清学检测是否能提供足够的证据来启动所有幽门螺杆菌。幽门螺杆菌阳性患者经验性抗生素治疗？
方法
H.使用决策树分析消化不良中的幽门螺杆菌。成功根除与治愈消化不良和预防消化性溃疡或胃癌的潜在益处相关。在敏感性分析中，所有的转换率和收益在很大范围内变化，以测试计算的决策结果的稳健性。
结果
血清学筛查的成本效益关系。消化不良患者中的幽门螺杆菌主要受非溃疡性消化不良对H.幽门螺杆菌根除率和预防溃疡的经济效益以及幽门螺杆菌感染者的消化性溃疡患病率是影响幽门螺杆菌根除率的主要因素。pylori阳性患者对H的回应pylori根除率为5-10%的非溃疡性消化不良患者可进行H.无论是否有任何其他潜在益处，幽门螺杆菌都是一个有益的选择。如果溃疡预防与4000美元或更多的长期效益相关，并且如果所有消化不良患者的溃疡患病率超过10%，则应进行H。幽门螺杆菌也会有回报。
结论
只要没有明确的证据表明非溃疡性消化不良对根除H。pylori，治疗所有H.不能推荐使用pylori。目前，抗生素治疗应保留给已证实有溃疡的患者或其他治疗方法无效的非溃疡性消化不良患者。
OBJECTIVES
It has remained controversial how to manage patients who present with symptoms of dyspepsia. Should all dyspeptic patients undergo a radiological or endoscopic procedure to diagnose peptic ulcer, or would a serological test for Helicobacter pylori provide sufficient evidence to start all H. pylori-positive patients on empirical antibiotic therapy?
METHODS
The outcome of serological testing for H. pylori in dyspepsia is analyzed using a decision tree. Successful eradication is associated with the potential benefits of healing dyspepsia and preventing peptic ulcer or gastric cancer. In a sensitivity analysis, all of the transition rates and benefits are varied over a wide range to test the robustness of the calculated decision outcomes.
RESULTS
The cost-benefit relationship of serological screening for H. pylori in dyspeptic patients is influenced primarily by the response rate of nonulcer dyspepsia to H. pylori eradication and secondly by the monetary benefit of ulcer prevention and the prevalence rate of peptic ulcer in H. pylori-positive patients. A response to H. pylori eradication in 5-10% of all patients with nonulcer dyspepsia would make screening and treatment for H. pylori a beneficial option, irrespective of any other potential benefits. If ulcer prevention were associated with long term benefit of $4000 or more and if the ulcer prevalence rate exceeded 10% of all dyspeptic patients, serological screening for H. pylori would also pay off.
CONCLUSIONS
As long as no unequivocal evidence exists that nonulcer dyspepsia responds to eradication of H. pylori, treating all dyspeptic patients who test positive for H. pylori cannot be recommended. At the present time, antibiotic therapy should be reserved to patients with proven ulcer or to patients with nonulcer dyspepsia for whom other measures have failed.