Cost-effectiveness of Helicobacter pylori "test and treat" for patients with typical reflux symptoms in a population with a high prevalence of H. pylori infection: a Markov model analysis.
OBJECTIVE
Patients with typical reflux symptoms may have underlying peptic ulcer disease (PUD) in a population with a high prevalence of Helicobacter pylori infection. In the present study we sought to compare the cost-effectiveness of the H. pylori "test and treat" strategy with that of empirical proton-pump inhibitor (PPI) therapy and endoscopy in patients with typical reflux and a high prevalence of H. pylori infection.


METHODS
A Markov model was designed to compare the outcomes of three treatment strategies over 12 months among a hypothetical cohort of patients presenting with typical reflux symptoms. There were four exclusive underlying H. pylori- and PUD-related comorbidities in the hypothetical cohort: (1) H. pylori-related PUD, (2) H. pylori infection without PUD, (3) PUD without H. pylori infection and (4) absence of both PUD and H. pylori infection. The transition probabilities and resource utilization were derived from the literature. Percentage of PUD patients treated, total number of symptom-free patient-years gained and total direct medical cost were estimated.


RESULTS
By comparing each strategy individually with the no therapy strategy, it was found that the incremental costs per ulcer treated for H. pylori "test and treat", endoscopy and empirical PPI therapy were USD 1778, USD 1797 and USD 2158, respectively. The results of the model were sensitive to the prevalence of H. pylori infection.


CONCLUSIONS
Both the H. pylori "test and treat" and initial endoscopic strategies were shown to be more cost-effective than empirical PPI therapy for treating undiagnosed PUD among patients presenting with typical reflux symptoms. The H. pylori "test and treat" strategy appeared to be only slightly more cost-effective than initial endoscopy in a population with a high prevalence of H. pylori infection.
You
Joyce H S
JH
School of Pharmacy, Faculty of Medicine, Centre for Pharmacoeconomics Research, Chinese University of Hong Kong, Hong Kong, China. joyceyou@cuhk.edu.hk
Wong
Pui-Lam
PL
Wu
Justin C Y
JC
D003362:Cost-Benefit Analysis; D005764:Gastroesophageal Reflux / Q000150:complications*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008390:Markov Chains; D010437:Peptic Ulcer / Q000150:complications; D015995:Prevalence; D054328:Proton Pump Inhibitors; D012680:Sensitivity and Specificity
D054328:Proton Pump Inhibitors