What is the optimal length of proton pump inhibitor-based triple therapies for 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.


OBJECTIVE
To determine whether length of treatment has an impact on the cost-effectiveness 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. Subjects were Helicobacter pylori-positive patients with a duodenal ulcer. The triple therapy trials spanned 7, 10 or 14 days and the main outcome measures were cost per patient and marginal cost for additional cured patient calculated for a low cost-of-care setting (Spain), for a high-cost setting (USA), and for two follow-up strategies: (i) systematic 13C-urea breath test after eradication; (ii) clinical follow-up, breath-test if symptoms recurred.


RESULTS
Base-case analysis showed that for both the 13C-UBT and the clinical follow-up branches, lowest costs were obtained with 7-day schedules both in Spain and the USA. Sensitivity analysis showed that in Spain, 10-day therapies would have to increase 7-day cure rates by 10-12% to become cost-effective. In contrast, in the USA only a 3-5% increase was needed. The corresponding figures for 14-day therapy were 25-35% and 8-11%, respectively.


CONCLUSIONS
Seven-day therapies seem the most cost-effective strategy. However, in high-cost areas the differences were less evident.
Calvet
X
X
Servei de Medicina, Corporació Sanitària Parc Taulí, Sabadell, Spain Servicio de Aparato Digestivo, Hospital de la Princesa, Madrid, Spain. xcalvet@cspt.es
Gené
E
E
López
T
T
Gisbert
J P
JP
D000658:Amoxicillin / Q000008:administration & dosage* / Q000191:economics / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics / Q000494:pharmacology; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000191:economics / Q000494:pharmacology; D001944:Breath Tests; D002247:Carbon Isotopes; D017291:Clarithromycin / Q000008:administration & dosage* / Q000191:economics / Q000494:pharmacology; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D016527:Drug Costs; D004381:Duodenal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D010406:Penicillins / Q000008:administration & dosage* / Q000191:economics / Q000494:pharmacology; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000191:economics; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D002247:Carbon Isotopes; D010406:Penicillins; D054328:Proton Pump Inhibitors; D017494:Proton Pumps; D000658:Amoxicillin; D014508:Urea; D017291:Clarithromycin