PHARMACOECONOMIC COMPARISON OF TREATMENTS FOR THE ERADICATION OF HELICOBACTER-PYLORI

Background: Patients with Helicobacter pylori-induced duodenal ulcer s hould have their infection eradicated. The optimal choice of antibioti c therapy, however, is less clear. Objective: To evaluate costs and ou tcomes of treatment with 8 antibiotic regimens with documented activit y against H pylori vs maintenance therapy with histamine(2)-receptor a ntagonists (H(2)RA). Methods: A meta-analysis for 119 studies enrollin g 6416 patients to determine aggregate eradication rates. The complexi ty of each regimen was used to determine the anticipated compliance ra te and actual effectiveness. A decision analytic model with Monte Carl o simulation determined annual costs and health outcomes. Results: Ave rage annual total costs of testing for H pylori infection and antibiot ic treatment ranged from $223 to $410 and prevented ulcer recurrence i n 70% to 86% of patients. The H(2)RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurre nce rates were achieved by 3 regimens: standard triple therapy (a comb ination of bismuth subsalicylate, metronidazole, and tetracycline hydr ochloride) for 14 days ($223, with 18% recurrence); a combination of c larithromycin, metronidazole, and a proton pump inhibitor for 7 days ( $235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence). Conclusion: Tre atment with any regimen resulted in lower costs compared with H(2)RA m aintenance therapy. Three antibiotic regimens had consistently lower c osts and better outcomes: standard triple therapy for 14 days, metroni dazole, clarithromycin, and a proton pump inhibitor for 7 days, and st andard triple therapy plus a proton pump inhibitor for 7 days.