COST-EFFECTIVENESS OF ALTERNATIVE HELICOBACTER-PYLORI ERADICATION STRATEGIES IN THE MANAGEMENT OF DUODENAL-ULCER

Published data and techniques for decision analysis were used to const ruct a model to estimate the cost. effectiveness of nine alternative s trategies for the management of patients diagnosed with uncomplicated duodenal ulcer. Two strategies of intermittent therapy with either ran itidine or omeprazole, one strategy of continuous maintenance treatmen t with ranitidine, and six strategies for ulcer healing and eradicatio n of Helicobacter pylori infection were considered. Healing time curve s were estimated by using published data, allowing for estimation of e xpected time for acute healing episodes. The expected number of weeks to heal per patient, in a one-year period, was estimated by combining healing time data with probability of ulcer recurrence. It was found t hat patients that underwent any of the six H pylori eradication regime ns had fewer days with ulcer per year than those who underwent mainten ance or intermittent ranitidine. Four eradication regimens had lower c osts and better outcomes than ranitidine therapy. In comparing H pylor i strategies, the two strategies of omeprazole plus one antibiotic (ei ther amoxicillin or clarithromycin) are more costly than omeprazole pl us two antibiotics (specifically amoxicillin and metronidazole or clar ithromycin and metronidazole) and result in similar outcomes. Although omeprazole based eradication regimens more costly than ranitidine bis muth triple therapy, they are associated with fewer recurrences of ulc er and days of symptoms. A limitation of the analysis is that it did n ot incorporate issues of compliance and metronidazole resistance; howe ver, the former concern may be less of an issue as H pylori regimens b ecome simpler and shorter in duration.