A COST-ANALYSIS OF A HELICOBACTER-PYLORI ERADICATION STRATEGY IN A LARGE HEALTH MAINTENANCE ORGANIZATION

Objectives: We sought to describe the effect of a Helicobacter pylori eradication strategy on health care costs among a cohort of health mai ntenance organization (HMO) members with peptic ulcer disease (PUD), M ethods: Patients were identified from an outpatient diagnosis database and verified at chart review to have new-onset PUD by upper endoscopy or upper gastrointestinal radiographic series. Health plan registrati on and accounting databases were used to track costs over 12 months af ter initial diagnosis. Costs mere analyzed separately for an initial 2 -month interval and a 10-month follow-up period. Inpatient and pharmac y costs are those directly attributable to PUD (either a PUD-related d ischarge diagnosis or an antiulcer medication prescription). Outpatien t costs are total costs, All cost differences were adjusted for age an d gender. Results: Twenty-seven of 93 patients meeting selection crite ria received H. pylori treatment. During the 2-month treatment window, adjusted PUD-related inpatient costs mere higher for the H. pylori tr eated group (difference, $234.00/person), whereas total outpatient cos ts and PUD-related pharmacy costs were similar. During the 10-month fo llow-up period, PUD-related inpatient and pharmacy adjusted costs were similar, but adjusted outpatient costs in the H. pylori treated group were lower than in the untreated group (difference, $508.00/person). Total adjusted follow-up period costs mere $555.00/person less in the H. pylori treated group (p = 0.05), Total 12-month costs in the H., py lori treated group were $285.00/per person less than in untreated pati ents, (p > 0.2); 30% of H. pylori treated patients were still receivin g antisecretory therapy 1 yr after diagnosis, compared to 41.9% of unt reated patients. Conclusions: H. pylori treatment is associated with a decreased cost of follow-up care for patients with PUD, primarily due to decreased outpatient utilization. (C) 1998 by Am. Coll. of Gastroe nterology.