Treatment of Helicobacter pylori infection in patients with duodenal ulcer: A cost-benefit study

Background: Epidemiological differences suggest that treatments for H. pylo ri eradication should be locally validated Aim: To perform a cost benefit s tudy of different treatment options for H. pylori infection. Patients and m ethods: One hundred and sixty-seven patients with active duodenal ulcer and H. pylori infection who completed a 2-week treatment with one of the follo wing regiments were included famotidine plus amoxycillin plus metronidazole (FAM), omeprazole plus amoxycillin plus tinidazole (OAT) or lansoprazole p lus clarithromycin plus amoxycillin in 3 (LAC1) or 2 (LAC2) daily doses. we compared efficacy, adverse effects and cost. Results: Eradication rate was 74.6, 72.9, 96.4 y 91.7% for FAM, OAT, LAC1 and LAC2 respectively (p<0.05) . Direct cost ranged from US$ 50 for FAM to US$ 220 for LAC1. A decision an alysis was carried out in a model including direct and indirect costs and c onsidering retreatment with antibiotics after the first treatment failure a nd one-year treatment with H2-blockers in case of a second failure. FAM was selected as the most cost-effective option, with an estimated cost of abou t US$ 300 +/- 148 per patient. However; cost associated to LAC2 was very si milar (US$ 320 +/- 58) and the lower standard deviation suggests less varia tion. Sensitivity analyses, considering reasonable fluctuation in parameter s such as eradication rate, cost and follow-up period suggest that a regime n containing a proton pump inhibitor clarithromycin and amoxycillin may be the most cost-effective treatment. Conclusions: These results should be con firmed in other settings, specially in ordinary clinical practice, far from clinical research.