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Question: What will happen if/when cheaper endoscopes become available—the small calibre transnasal endoscopes—which do not require the patient to be sedated? Will we need to test and treat? I am thinking of endoscopes that cost, say, US$10 each, which could be used in primary care.
Dr Moayyedi: First of all, this technology is not yet available. I also find it hard to believe that an endoscope would ever cost as little as US$10, as the technology is still expensive, and it would be even more expensive if it were available to every primary care physician. Secondly, we can of course make endoscopy cheaper in our decision analysis; however, even if the cost of endoscopy goes below US$100, a test and treat strategy is still more cost effective.
Question: Due to the fact that so many serological tests are less than 90% sensitive and specific, as well as the reduction in the prevalence of Helicobacter pylori in many countries, should we abandon serology and use only a breath test for the test and treat strategy?
Professor Axon: We require a non-invasive way to detect H pylori with 98% accuracy at reasonable cost. If we can make the breath test cheaper (and I can see no reason why we cannot do this) or if we make serology more accurate, either would be appropriate.
Question: Dr Moayyedi, in some decision analyses and, particularly, in decision analyses with children, the test and treat strategy is not really cost effective. What is your view on this?
Dr Moayyedi: I think to a certain extent you are correct. The cost effectiveness of a test and treat strategy depends on the prevalence of H pylori in the population. In the paediatric population, the prevalence of H pylori is very low. Therefore, in children in the developed world, a test and treat strategy may not be the most …