Cost effectiveness in Canada of a multidrug prepackaged regimen (Hp-PAC)+ for Helicobacter pylori eradication.
OBJECTIVE
To assess the cost effectiveness of a multidrug prepackaged regimen for Helicobacter pylori, the Hp-PAC (lansoprazole 30mg, clarithromycin 500 mg, amoxicillin 1 g, all twice daily), relative to alternative pharmacological strategies in the management of confirmed duodenal ulcer over a 1-year period from 2 perspectives: (i) a strict healthcare payer perspective (Ontario Ministry of Health) excluding the patient copayment; and (ii) a healthcare payer perspective including the patient copayment.


METHODS
A decision-analytical model was developed to estimate expected per patient costs [1998 Canadian dollars ($ Can)], weeks without ulcer and symptomatic ulcer recurrences for the Hp-PAC compared with: proton pump inhibitor (PPI)-clarithromycin-amoxicillin (PPI-CA), PPI-clarithromycin-metronidazole (PPI-CM), PPI-amoxicillin-metronidazole (PPI-AM) and ranitidine-bismuthmetronidazole-tetracycline (RAN-BMT).


RESULTS
All PPI-based regimens had higher expected costs but better outcomes relative to RAN-BMT. From a strict healthcare payer perspective, PPI-CM ($Can 209) yielded lower expected costs than PPI-CA ($Can 221) and slightly lower costs than Hp-PAC ($Can 211). However, these 3 regimens all shared identical outcomes (51.2 weeks without ulcer). When the current Ontario, Canada, $Can 2 patient copayment was added to the dispensing fee, Hp-PAC yielded lower costs ($Can 214) than PPI-CM ($Can 216).


CONCLUSIONS
From a strict healthcare payer perspective, Hp-PAC is weakly dominated by PPI-CM with an incremental cost effectiveness (relative to RAN-BMT) of $Can 5.77 per ulcer week averted. When the patient copayment is added to this perspective, Hp-PAC weakly dominates PPI-CM ($Can 5 per ulcer week averted). Regardless of perspective, Hp-PAC and PPI-CM differed by only $Can 2 per patient over 1 year and the expected time without ulcer was 51.2 weeks for both. More data on the clinical and statistical differences in H. pylori eradication with Hp-PAC and PPI-CM would be useful. This analysis does not in clude the possible advantage of Hp-PAC in terms of compliance and antibacterial resistance.
Agro
K
K
Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, Ontario, Canada.
Blackhouse
G
G
Goeree
R
R
Willan
A R
AR
Huang
J Q
JQ
Hunt
R H
RH
O'Brien
B J
BJ
D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D017850:Economics, Pharmaceutical; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D010437:Peptic Ulcer / Q000188:drug therapy / Q000191:economics
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents