Delay expensive invasive tests for patients with suspected ulcers

August 14, 1995

ANN ARBOR— University of Michigan researchers are proposing new recommendations for treating patients with ulcer-like symptoms that could save millions of health care dollars while allowing many patients to avoid uncomfortable and costly invasive procedures.

Recently researchers discovered that nearly all people with ulcers are also infected with H. pylori bacteria” an infection linked to ulcer recurrence. Guidelines such as those from the National Institutes of Health recommend the use of antibiotics to eradicate H. pylori infection only if both an ulcer and H. pylori are objectively diagnosed. ” Consequently, an increasing number of physicians are likely to recommend an endoscopy to confirm these diagnoses before prescribing antibiotic therapy,” said Dr. A. Mark Fendrick of the U-M School of Public Health and the Medical School.

Based on a cost effectiveness analysis, however, Fendrick and his colleagues are recommending that physicians delay immediate endoscopy in favor of a less invasive blood test for H. pylori. Patients with a positive test should receive antibiotic therapy in addition to the use of the usual antisecretory drugs. If patients’ symptoms fail to disappear after initial treatment, endoscopy should then be performed.

The U-M study is unique in that it examines treatment strategies for patients with ulcer-like symptoms as opposed to the 20 percent of patients who actually suffer from ulcers. The study, which is based on a computer simulation, reflects a new trend in health care research that merges the expertise of physicians and economists to identify optimal treatments that are safe, beneficial and cost effective. The researchers’ recommendations are published in the Aug. 15 issue of the Annals of Internal Medicine.

Fendrick’s colleagues involved in the study were assistant professors Michael E. Chernew and Richard A. Hirth of the U-M School of Public Health and Bernard S. Bloom of the Leonard Davis Institute of Health Economics at the University of Pennsylvania.

The study compared the medical and economic impact of treatment strategies that differed according to their initial steps” immediate endoscopy versus non-invasive treatment, with or without a blood test for H. pylori.

” Each strategy worked equally well from a clinical perspective in that nearly all the ulcers were healed,” said Fendrick, ” but the per patient cost of non-invasive strategies which avoided initial endoscopy (approximately which called for initial invasive testing (approximately

” If the price of an endoscopy dropped to less than with the non-invasive strategies would disappear.”

The researchers also note that many physicians are justifiably concerned about the overuse of antibiotics and potential bacterial resistance. ” Given those concerns, we strongly recommend that symptomatic patients receive a blood test for H. pylori [about $25] and reserve antibiotic therapy for patients who test positive.”

Wono Lee

Michael E. ChernewWono Lee