Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia

Objectives To evaluate efficacy and cost effectiveness of Helicobacter pylo ri eradication treatment in patients with non-ulcer dyspepsia infected with H pylori. Design Systematic review of randomised controlled trials comparing H pylori eradication with placebo or another drug treatment Results were incorporat ed into a Markov model comparing health service costs and benefits of H pyl ori eradication with antacid treatment over one year. Data sources Six electronic databases were searched for randomised controll ed trials from January 1966 to May 2000. Experts in the field, pharmaceutic al companies, and journals were contacted for information on any unpublishe d trials. Trial reports were reviewed according to predefined eligibility a nd quality criteria. Main outcome measures Relative risk reduction for remaining dyspeptic sympt oms (the same or worse) at 3-12 months. Cost per dyspepsia-free month estim ated from Markov model based on estimated relative risk reduction. Results Twelve trials were included in the systematic review, nine of which evaluated dyspepsia at 3-12 months in 2541 patients. H pylori eradication treatment was significantly superior to placebo in treating non-ulcer dyspe psia (relative risk reduction 9% (95% confidence interval 4% to 14%)), one case of dyspepsia being cured for every 15 people treated. H pylori eradica tion cost pound 56 per dyspepsia-free month during first year after treatme nt Conclusion H pylori eradication may he cost effective treatment for non-ulc er dyspepsia in infected patients but further evidence is needed on decisio n makers' willingness to pay for relief of dyspepsia.