Economic consequences of near-patient test results:: the case of tests for the Helicobacter Pylori bacterium in dyspepsia

We have developed a model for economic evaluation related to the diagnostic accuracy (sensitivity and specificity) of near patient tests used in office laboratories, as opposed to using hospital-based tests. Blood-sample based tests to detect the bacterium Helicobacter Pylori (HP) are useful in diagnosing peptic ulcer, and suitable to illustrate the model. First, general practitioners' initial management plans for a dyspeptic patient are elucidated using a paper vignette survey. Based on survey results, and medical literature, a decision tree is constructed to visualize expected costs and outcomes resulting from using three different HP tests. Tests included are two rapid tests for use in general practice, and one hospital laboratory test for comparison. The tests had different sensitivities and specificities. Then a cost-effectiveness analysis is undertaken from a societal perspective. Finally we use sensitivity analyses to model the decision uncertainty. Estimating for a follow-up period of 120 days, the rapid test with lower sensitivity and specificity than the hospital HP test is cost-effective because the test result is available immediately. Further, in general practice, the rapid test with the highest sensitivity is significantly cost effective compared to the test with the highest specificity when the willingness to pay for each dyspepsia-free day exceeds (sic)42.6. When deciding whether a laboratory analysis should be analyzed in the office laboratory or not, it is important to consider both the diagnostic accuracy of the tests and waiting time for the alternative hospital laboratory result.