What is the optimal length of proton pump inhibitor-based triple therapiesfor H-pylori? A cost-effectiveness analysis

Background: Triple therapy with a proton pump inhibitor, clarithromycin and amoxicillin is widely used for H. pylori infection. The appropriate length of treatment remains controversial. Aim: To determine whether length of treatment has an impact on the cost-eff ectiveness of triple therapy. Methods: The study took the form of a cost-effectiveness analysis spanning 2 years. The perspective was societal and the setting, ambulatory care. Sub jects were Helicobacter pylori-positive patients with a duodenal ulcer. The triple therapy trials spanned 7, 10 or 14 days and the main outcome measur es were cost per patient and marginal cost for additional cured patient cal culated for a low cost-of-care setting (Spain), for a high-cost setting (US A), and for two follow-up strategies: (i) systematic C-13-urea breath test after eradication; (ii) clinical followup, breath-test if symptoms recurred . Results: Base-case analysis showed that for both the C-13-UBT and the clini cal follow-up branches, lowest costs were obtained with 7-day schedules bot h in Spain and the USA. Sensitivity analysis showed that in Spain, 10-day t herapies would have to increase 7-day cure rates by 10-12% to become cost-e ffective. In contrast, in the USA only a 3-5% increase was needed. The corr esponding figures for 14-day therapy were 25-35% and 8-11%, respectively. Conclusions: Seven-day therapies seem the most cost-effective strategy. How ever, in high-cost areas the differences were less evident.