Costs of Managing Helicobacter pylori-infected ulcer patients after initial therapy

Background. The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated fo r peptic ulcer disease and Helicobacter pylori infection. Materials and Methods. A decision-analytic model was used to compare (1a) u rease breath testing (UBT) for assessment of H. pylori status versus (1b) o bservation without further testing or treatment, among patients who were sy mptom-free following initial antimicrobial and antisecretory therapy for en doscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versu s (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat anti microbial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. Results, Among patients who were symptom free after initial therapy, 6.1% r eceiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient foll owing initial therapy was $591 for UBT compared to $480 for observation. Am ong patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receivi ng repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs p er patient were, respectively, $766, $1787 and $1122. Conclusions. The optimal approach to managing patients following initial tr eatment for ulcer and H. pylori infection depends on symptom status followi ng initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For p atients without symptoms following initial therapy, UBT is the preferred ap proach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compar ed with observation.