Immediate eradication of Helicobacter pylori in patients with previously documented peptic ulcer disease: clinical and economic effects.
OBJECTIVE
The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost-effectiveness of H. pylori eradication in the large cohort of asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer disease.


METHODS
A decision analytic model estimated the clinical and economic effects of two management strategies for asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, and strategy 2-continued-maintenance antisecretory therapy, with H. pylori eradication therapy reserved for the first symptom recurrence.


RESULTS
At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36.8 ulcer months/100 patient years), 10% fewer months with ulcer symptoms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per-patient expenditures ($587 vs. $767/patient year) than maintenance antisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more months with upper gastrointestinal symptoms from all causes (37.9 vs. 33.2 symptom months/100 patient years) than strategy 2, because maintenance antisecretory therapy was effective in treating symptoms due to causes other than peptic ulcer disease.


CONCLUSIONS
Ulcer-related outcomes of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori eradication at reduced cost. Therefore, H. pylori eradication should be aggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.
Fendrick
A M
AM
Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor 48109-0376, USA.
McCort
J T
JT
Chernew
M E
ME
Hirth
R A
RA
Patel
C
C
Bloom
B S
BS
D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D008390:Markov Chains; D010437:Peptic Ulcer / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D012008:Recurrence; D012680:Sensitivity and Specificity; D013997:Time Factors
D000897:Anti-Ulcer Agents