The cost-effectiveness of competing strategies for the prevention of recurrent peptic ulcer hemorrhage.
OBJECTIVE
Several strategies exist for the prevention of recurrent ulcer-related hemorrhage, yet the cost-effectiveness has not been evaluated and remains uncertain. The aim of this study was to compare the cost-effectiveness of competing management strategies considering both nonsteroidal anti-inflammatory drugs status and the accuracy of Helicobacter pylori (H. pylori) testing.


METHODS
Decision analysis was used to compare the cost-per-recurrent hemorrhage prevented for 11 strategies over 1 yr. Clinical and costs estimates were derived from a systematic review of the medical literature and the Medicare Fee Schedule and Drug Topics Redbook. Sensitivity analyses were performed for important variables.


RESULTS
The test/retest eradication strategy with maintenance proton pump inhibitor therapy for H. pylori-negative patients was most effective (prevention of recurrence in 96.0%). The test/retest eradication strategy with maintenance histamine-2 receptor antagonist therapy for H. pylori-negative patients was least costly ($1070). The test/retest strategies were dominant with average cost-effectiveness ratios of $1118-1310/recurrent hemorrhage prevented with maintenance antisecretory therapy. The average cost-effectiveness ratios for "selective" H. pylori eradication strategies with maintenance antisecretory therapy were $1263-1673. The model was robust to varying estimates over prespecified ranges.


CONCLUSIONS
Test/retest strategies for H. pylori are cost-effective for the prevention of recurrent ulcer-related hemorrhage because they maximize H. pylori detection and eradication, resulting in fewer recurrent hemorrhages and fewer patients requiring antisecretory therapy.
Ofman
Joshua
J
Zynx Health, Subsidiary of Cedars-Sinai Health System, Beverly Hills, California 90212, USA.
Wallace
Joel
J
Badamgarav
Enkhe
E
Chiou
Chiun-Fang
CF
Henning
James
J
Laine
Loren
L
D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016480:Helicobacter pylori; D006635:Histamine H2 Antagonists / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D012008:Recurrence
D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists