IMMEDIATE ERADICATION OF HELICOBACTER-PYLORI IN PATIENTS WITH PREVIOUSLY DOCUMENTED PEPTIC-ULCER DISEASE - CLINICAL AND ECONOMIC-EFFECTS

Objectives: The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost -effectiveness of H. pylori eradication in the large cohort of asympto matic patients receiving maintenance antisecretory therapy for a previ ously documented peptic ulcer disease. Methods: A decision analytic mo del estimated the clinical and economic effects of two management stra tegies for asymptomatic patients receiving maintenance antisecretory t herapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, an d strategy 2-continued-maintenance antisecretory therapy, with H. pylo ri eradication therapy reserved for the first symptom recurrence. Resu lts: At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36 .8 ulcer months/100 patient years), 10% fewer months with ulcer sympto ms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per -patient expenditures ($587 vs. $767/patient year) than maintenance an tisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more mon ths with upper gastrointestinal symptoms from all causes (37.9 vs. 33. 2 symptom months/100 patient years) than strategy 2, because maintenan ce antisecretory therapy was effective in treating symptoms due to cau ses other than peptic ulcer disease. Conclusions: Ulcer-related outcom es of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori era dication at reduced cost. Therefore, N. pylori eradication should be a ggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.