Background. There are several diagnostic methods for Helicobacter pylori (H. pylori) infection. A cost-effective analysis is needed to\ndecide on the optimal diagnostic method. The aim of this study was to determine a cost-effective diagnostic method in patients with\natrophic gastritis (AG). Methods. A decision-analysis model including seven diagnostic methods was constructed for patients with\nAG diagnosed by esophagogastroduodenoscopy. Expected values of cost and effectiveness were calculated for each test. Results. If\nthe prevalence of H. pylori in the patients with AG is 85% and CAM-resistant H. pylori is 30%, histology, stool H. pylori antigen\n(SHPAg), bacterial culture (BC), and urine H. pylori antibody (UHPAb) were dominated by serum H. pylori IgG antibody\n(SHPAb), rapid urease test (RUT), and urea breath test (UBT). Among three undominated methods, the incremental costeffective\nratios (ICER) of RUT versus SHPAb and UBT versus RUT were $214 and $1914, respectively. If the prevalence of\nCAM-sensitive H. pylori was less than 55%, BC was not dominated, but its H. pylori eradication success rate was 0.86.\nConclusions. RUT was the most cost-effective at the current prevalence of CAM-resistant H. pylori. BC could not be selected due\nto its poor effectiveness even if CAM-resistant H. pylori was more than 45%.
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