[Cost-effectiveness analysis of 2 strategies of Helicobacter pylori eradication: results of a prospective and randomized study in primary care].
BACKGROUND
To analyze cost-effectiveness of two different strategies to treat H. pylori infection in peptic ulcer in the primary care setting.


METHODS
Consecutive patients with endoscopic diagnosis of peptic ulcer were randomized to one of two strategies: a) treatment during 7 days with omeprazole, tetracycline, metronidazole and bismuth subcitrate ("quadruple" therapy) and if failure second-line treatment with omeprazole, amoxycillin and clarithromycin during 7 days (OCA7), and b) initial treatment with OCA7 and if failure treatment with "quadruple therapy". End point was eradication 8 weeks after last treatment dose. Direct and indirect costs were estimated (euros, 1997) and a cost-effectiveness analysis using a decision-tree model was undertaken after real clinical data. 95% confidence intervals are given.


RESULTS
After screening 255 patients, 97 were finally included. 48 patients were given strategy a and 49 strategy b. Eradication was obtained (intention-to-treat) in 72.9% (CI 95%: 58.2-84.7) in group a versus 91.8% (CI 95%: 80.4-97.7) (p < 0.05) in group b. Mean cost per case treated was lower in group a (237 versus 268 euros) but cost per case eradicated was lower in group b (320 versus 296 euros). The cost was primarily determined by efficacy.


CONCLUSIONS
Treatment with OCA7 followed by rescue with "quadruple" therapy if failure is more efficient in our area that the inverse strategy. Efficiency is mostly determined by efficacy.
Gomollón
F
F
Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza. fgomollong@meditex.es o fgomollon@ingenia.es
Valdepérez
J
J
Garuz
R
R
Fuentes
J
J
Barrera
F
F
Malo
J
J
Tirado
M
M
Simón
M A
MA
D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D017291:Clarithromycin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000188:drug therapy / Q000191:economics; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D010406:Penicillins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D011320:Primary Health Care; D011446:Prospective Studies; D013276:Stomach Ulcer / Q000188:drug therapy / Q000191:economics; D013752:Tetracycline / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009942:Organometallic Compounds; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin; C002791:bismuth tripotassium dicitrate; D009853:Omeprazole