A COST-ANALYSIS OF ALTERNATIVE TREATMENTS FOR DUODENAL-ULCER

Objective: To compare the costs of alternative strategies for the trea tment of duodenal ulcer. Design: A cost comparison using decision anal ysis. Methods: A decision model was used to compare the costs per cure of an endoscopically documented duodenal ulcer for three initial trea tment strategies: 1) H-2-receptor antagonist therapy for 8 weeks, 2) a ntibiotic therapy for Helicobacter pylori infection plus H-2-receptor antagonist therapy, and 3) urease test-based treatment. For symptomati c recurrences, secondary treatment strategies included empiric retreat ment with the same or other regimen, and treatment based on repeat end oscopy-guided urease test or biopsy, with an assumption of subsequent cure. The cohort modeled for this analysis consisted of patients at lo w risk for a malignant ulcer. probability estimates were derived from published clinical trials, cohort studies, and expert opinion. Side ef fects from combination therapy with antibiotics and H-2-receptor antag onists and resulting costs were included from the perspective of a gro up practice model health maintenance organization. Results: For all se condary treatment strategies, initial therapy with antibiotics for H. pylori infection plus an H-2-receptor antagonist resulted in the lowes t average costs per symptomatic cure when the prevalence or likelihood of H. pylori infection exceeded 66% to 76%; the costs ranged from $28 4 for secondary (re)treatment with empiric antibiotic and H-2-receptor antagonist therapy to $398 for endoscopy-guided secondary treatment. Initial treatment with an H-2-receptor antagonist resulted in the high est costs, ranging from $372 for secondary treatment with empiric anti biotic and H-2-receptor antagonist therapy to $679 for endoscopy-guide d secondary treatment. The results were not sensitive to the rates of duodenal ulcer recurrence after either treatment, to the cost of eithe r treatment, or to prevalence of H. pylori. Conclusions: This cost ana lysis indicates that, regardless of the secondary treatment used for u lcer recurrence, initial therapy with antibiotics for H. pylori infect ion plus an H-2-receptor antagonist provides the lowest costs per symp tomatic cure. These cost savings and the lower recurrence rates associ ated with this treatment favor eradication of H. pylori as part of the initial treatment of duodenal ulcer.