Cost effectiveness in Canada of a multidrug prepackaged regimen (Hp-PAC (R)) for Helicobacter pylori eradication

Objective: To assess the cost effectiveness of a multidrug prepackaged regi men for Helicobacter pylori, the Hp-PAC (R) (lansoprazole 30mg, clarithromy cin 500mg, amoxicillin 1 g, all twice daily), relative to alternative pharm acological strategies in the management of confirmed duodenal ulcer over a 1-year period from 2 perspectives: (i) a strict healthcare payer perspectiv e (Ontario Ministry of Health) excluding the patient copayment; and (ii) a healthcare payer perspective including the patient copayment. Design: A decision-analytical model was developed to estimate expected per patient costs [1998 Canadian dollars ($Can)], weeks without ulcer and sympt omatic ulcer recurrences for the Hp-PAC (R) compared with: proton pump inhi bitor (PPI)-clarithromycin-amoxicillin (PPI-CA), PPI-clarithroillycin-metro nidazole (PPI-CM), PPI-amoxicillin-metronidazole (PPI-AM) and ranitidine-bi sinuth-metronidazole-tetracycline (RAN-BMT). Main outcome measures and results: All PPI-based regimens had higher expect ed costs but better outcomes relative to RAN-BMT. From a strict healthcare payer perspective, PPI-CM ($Can209) yielded lower expected costs than PPI-C A ($Can221) and slightly lower costs than Hp-PAC (R) ($Can211). However, th ese 3 regimens all shared identical outcomes (51.2 weeks without ulcer). Wh en the current Ontario, Canada, $Can2 patient copayment was added to the di spensing fee, Hp-PAC (R) yielded lower costs ($Can214) than PPI-CM ($Can216 ). Conclusion: From a strict healthcare payer perspective, Hp-PAC (R) is weakl y dominated by PPI-CM with an incremental cost effectiveness (relative to R AN-BMT) of $Can5.77 per ulcer week averted. When the patient copayment is a dded to this perspective, Hp-PAC (R) weakly dominates PPI-CM ($Can5 per ulc er week averted). Regardless of perspective, Hp-PAC (R) and PPI-CM differed by only $Can2 per patient over I year and the expected time without ulcer was 51.2 weeks for both. More data on the clinical and statistical differen ces in H. pylori eradication with Hp-PAC (R) and PPI-CM would be useful. Th is analysis does not include the possible advantage of Hp-PAC (R) in terms of compliance and antibacterial resistance.