Pharmacoeconomic comparison of treatments for the eradication of Helicobacter pylori.
BACKGROUND
Patients with Helicobacter pylori-induced duodenal ulcer should have their infection eradicated. The optimal choice of antibiotic therapy, however, is less clear.


OBJECTIVE
To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine2-receptor antagonists (H2RA).


METHODS
A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates. The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness. A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes.


RESULTS
Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients. The H2RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence).


CONCLUSIONS
Treatment with any regimen resulted in lower costs compared with H2RA maintenance therapy. Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days.
Taylor
J L
JL
Technology Assessment Group, San Francisco, Calif, USA.
Zagari
M
M
Murphy
K
K
Freston
J W
JW
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D001729:Bismuth / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000191:economics / Q000627:therapeutic use; D009010:Monte Carlo Method; D009942:Organometallic Compounds / Q000191:economics / Q000627:therapeutic use; D010349:Patient Compliance; D054328:Proton Pump Inhibitors; D012008:Recurrence; D012459:Salicylates / Q000191:economics / Q000627:therapeutic use; D013752:Tetracycline / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009942:Organometallic Compounds; D054328:Proton Pump Inhibitors; D012459:Salicylates; D008795:Metronidazole; C015715:bismuth subsalicylate; D013752:Tetracycline; D017291:Clarithromycin; D001729:Bismuth