Management of Helicobacter pylori in duodenal ulcer: a cost-effectiveness analysis

Background: Empirical eradication therapy of H. pylori has been proposed as a therapeutic alternative for duodenal ulcer. Aim: To identify the cost-effectiveness of empirical eradication therapy vs . test-and-treatment for the management of patients already diagnosed with a duodenal ulcer. Methods: A decision analysis was performed to compare the cost-effectivenes s of empirical eradication therapy of H. pylori diagnosed duodenal ulcer vs . eradication therapy after confirmatory diagnosis of Helicobacter pylori i nfection by means of several diagnostic tests. Results: The empirical eradication therapy of duodenal ulcer was found to b e the most effective and cost-effective strategy of all the alternatives. A mongst the alternatives, which included the previous performance of confirm atory diagnostic tests, the best cost-effectiveness ratio used a serology t est. The model was robust in the face of changes in the values of therapeut ic effectiveness, sensitivity and specificity of the diagnostic tests, prev alence of H. pylori infection in duodenal ulcer, duration of the antisecret ory therapy, and number of medical visits. Conclusions: Based on our cost-effectiveness analysis, a treat approach is more effective and cost-effective than a test-and-treat approach in the cli nical management of already diagnosed duodenal ulcer.