Economic evaluation of Helicobacter pylori eradication in the CADET-Hp randomized controlled trial of H. pylori-positive primary care patients with uninvestigated dyspepsia.
BACKGROUND
Adult Helicobacter pylori-positive patients by 13C-urea breath test with uninvestigated dyspepsia symptoms were randomized to 1-week eradication treatment with omeprazole, metronidazole and clarithromycin (OMC) vs. omeprazole and placebo antimicrobials (OPP) in the Canadian Adult Dyspepsia Empiric Treatment-H. pylori-positive (CADET-Hp) study.


OBJECTIVE
To perform an economic evaluation of this 1-year study.


METHODS
Following blind eradication treatment, family practitioners managed patients according to their usual practices. Health resource utilization information was collected prospectively. From the mean costs of the health resources consumed and the treatment outcomes, the incremental cost-effectiveness ratios and incremental net benefits of eradication treatment vs. OPP were determined.


RESULTS
Eradication therapy significantly improved dyspepsia symptoms (treatment success: OMC, 50%; OPP, 36%; P = 0.02). The incremental cost-effectiveness ratio of OMC vs. OPP was - 387 Canadian dollars (CAD$) per treatment success (90% CI, - CAD$1707, CAD$607), indicating a lower cost with treatment success. The incremental net benefit analysis showed that H. pylori eradication was cost-effective if the willingness-to-pay value exceeded a nominal figure of CAD$100 from a health service perspective or CAD$607 from the societal perspective.


CONCLUSIONS
In uninvestigated patients presenting with dyspepsia at the primary care level, eradication of H. pylori in those who are H. pylori positive leads to a cost-effective improvement in dyspepsia symptoms compared with a strategy of not eradicating H. pylori in these patients.
Surrey GI Clinic/Research, Guelph, Ontario, Canada. chiban@on.aibn.com
N
N
Chiba
S J O
SJ
Veldhuyzen Van Zanten
S
S
Escobedo
E
E
Grace
J
J
Lee
P
P
Sinclair
A
A
Barkun
D
D
Armstrong
A B R
AB
Thomson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics; D000897:Anti-Ulcer Agents; D017291:Clarithromycin / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000191:economics* / Q000382:microbiology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000191:economics; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000191:economics; D011446:Prospective Studies
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000897:Anti-Ulcer Agents; D008795:Metronidazole; D017291:Clarithromycin; D009853:Omeprazole