Re: Testing for Helicobacter pylori Infection After Antibiotic Treatment—Reply

Abstract

To the Editor. We appreciate Dr. Faust's comments on our editorial concerning post-treatment testing for Helicobacter pylori. As Dr. Faust correctly points out, breath testing will only become a feasible option in clinical if and when two requirements are met; firstly, that the test is readily available through reference laboratories in hospitals, clinic, and pathology services; and, secondly, that the cost of the test is reimbursed or inexpensive. In Australia, the costs of procedures and tests are met to a substantial level by a combination of government subsidies through Medicare and by the private health insurance funds. On average, endoscopy as a day case in a free-standing or hospital day surgery unit in Australia amounts to approximately $US623, the cost being a sum of procedure fee ($US115), facility fee ($US335), anesthetic fee ($US90), rapid urease test ($US3), and histopathology fee ($US80). Medicare in Australia has already agreed to a fee for 13C-urea and 14C-urea breath testing for SUS40. Certainly in this country, it can be appreciated that a breath test only costs 6.5% of the fee for repeat endoscopy and biopsy. In many other regions, particularly in Europe, 13C urea breath testing has already become the gold standard method for post-treatment testing, and this has been endorsed recently by the Maastricht Consensus Report (1). Given its accuracy, economy, convenience, safety, and patient acceptability, it should replace endoscopic biopsy as the first choice post-treatment test in the USA provided the above requirements are realized and met by the funding bodies. This would seem to be a priority need for routine clinical practice in the USA.