Optimal treatment for duodenal ulcer disease: A cost-decision analysis in Malaysian patients

The aim of the present study was to determine the cost-efficiency of differ ent duodenal ulcer disease treatment practices in Malaysia. Six Malaysian g astroenterologists met to discuss the direct costs related to Helicobacter pylori (HP) eradication treatment. Five treatment strategies were compared: (i) histamine H-2 receptor antagonists (H(2)RA), acid suppression therapy for 6 weeks followed by maintenance therapy as needed; (ii) bismuth triple + proton pump inhibitor (PPI), bismuth (120 mg, q.i.d.), metronidazole (400 mg; t.i.d.), tetracycline (500 mg, q.i.d.) for 7 days and PPI, b.i.d., fur 7 days; (iii) OAC, omeprazole (20 mg, b.i.d.), amoxycillin (1000 mg, b.i.d .) and clarithromycin (500 mg, b.i.d.) for 7 days; (iv) OMC, omeprazole (20 mg, b.i.d.), metronidazole (400 mg, b.i.d.) and clarithromycin (500 mg, b. i.d.) for 7 days; and (v) OAM, omeprazole (20 mg, b.i.d.), amoxycillin (100 0 mg, b.i.d.) and metronidazole (400 mg, b.i.d.) for 7 days. A decision tre e model was created to determine which therapy would be the most cost-effec tive. The model considered eradication rates, resistance to anti-microbial agents, compliance and cost implications of treatment regimens, physician v isits and ulcer recurrences during a 1 year time period assumption. The H(2 )RA. maintenance therapy was the most expensive treatment at Malaysian Ring git (MR) 2335, followed by bismuth triple therapy (MR 1839), OMC (MR 1786), OAM (MR 1775) and OAC, being the most cost-effective therapy, at MR 1679. In conclusion, HP eradication therapy is superior to H(2)RA maintenance the rapy in the treatment of duodenal ulcer disease. Of the HP eradication regi mens, OAC is the most cost-affective.