Cost/effectiveness analysis of two strategies for Helicobacter pylori eradication: results of a prospective and randomized study in primary care setting

BACKGROUND: TO analyze cost-effectiveness of two different strategies to tr eat H. pylori infection in peptic ulcer in the primary care setting. PATIENTS AND METHODS: Consecutive patients with endoscopic diagnosis of pep tic ulcer were randomized to one of two strategies: al treatment during 7 d ays with omeprazole, tetracycline, metronidazole and bismuth subcitrate ("q uadruple" therapy) and if failure second-line treatment with omeprazole, am oxycillin and clarithromycin during 7 days (OCA7), and b) initial treatment with OCA7 and if failure treatment with "quadruple therapy". End point was eradication 8 weeks after last treatment dose. Direct and indirect costs w ere estimated (euros, 1997) and a cost-effectiveness analysis using a decis ion-tree model was undertaken after real clinical data. 95% confidence inte rvals are given. RESULTS: After screening 255 patients, 97 were finally included. 48 patient s were given strategy a and 49 strategy b. Eradication was obtained (intent ion-to-treat) in 72.9% (CI 95%: 58.2-84.7) in group a versus 91.8% (CI 95%: 80.4-97.7) (p < 0.05) in group b. Mean cost per case treated was lower in group a (237 versus 268 euros) but cost per case eradicated was lower in gr oup b (320 versus 296 euros). The cost was primarily determined by efficacy . diagnosis daysCONCLUSIONS: Treatment with OCA7 followed by rescue with "qua druple" therapy if failure is more efficient in our area that the inverse s trategy. Efficiency is mostly determined by efficacy.