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Background . There are several diagnostic methods for  Helicobacter pylori (H. pylori)  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).  Methods . 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.  Results . If the prevalence of  H. pylori  in the patients with AG is 85% and CAM-resistant  H. pylori  is 30%, histology, stool  H. pylori  antigen (SHPAg), bacterial culture (BC), and urine  H. pylori  antibody (UHPAb) were dominated by serum  H. pylori  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  H. pylori  was less than 55%, BC was not dominated, but its  H. pylori  eradication success rate was 0.86.  Conclusions . RUT was the most cost-effective at the current prevalence of CAM-resistant  H. pylori . BC could not be selected due to its poor effectiveness even if CAM-resistant  H. pylori  was more than 45%.

Cost-Effectiveness Analysis ofHelicobacter pyloriDiagnostic Methods in Patients with Atrophic Gastritis