Helicobacter pylori感染の診断検査の有効性と費用

Objective : To evaluate and compare efficacy, costs and efficiency of three diagnostic tests for Helicobacter pylori (H.pylori) infection among patients with peptic ulcer and dyspepsia patients. Methods : All English and Japanese articles from 1988 to 1999 about diagnostic tests for H.pylori were identified by MEDLINE (for English) and JAPICDOC (for Japanese) search. They are complemented by manual search. As diagnostic tests, invasive (culture and histological detection) and non-invasive (13C-UBT) tests were used. Meta-analysis of sensitivity, specificity and accuracy of tests was done. Costs were identified and caluculated from reimbursement rate in the National Health Insurance. Cost-effectiveness analysis from a perspective of the third party payer was done to evaluate efficiency of these tests. Sensitivity analysis was carried out to examine the stability of the results of economic evaluation. Results : While 13C-UBT had the highest sensitivity (97%), culture test had the highest specificity (100%). Accuracy was the highest in 13C-UBT (96%). Direct costs were the lowest in 13C-UBT ($112). Cost-effectiveness analysis showed that 13C-UBT was dominant among these tests. Sensitivity analysis of test sensitivity, costs and prevalence confirmed these results. Conclusion : These results suggest that 13C-UBT is an effective and efficient diagnostic test for H.pylori infection. 13C-UBT may warrant wide utilization. Since there are several limitations in this study, further research should be done to confirm this study.