Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost-effective: economic analysis of the HELPUP trial.
BACKGROUND
Proton pump inhibitor (PPI) use is costly and about two-thirds of prescribing is long-term. Although 20-50% of patients may be infected with Helicobacter pylori, eradication is not normal clinical practice.


OBJECTIVE
To establish if H. pylori eradication in long-term PPI users is cost-effective.


METHODS
Long-term PPI-using patients (n = 183) testing positive for H. pylori were randomly assigned to true or placebo eradication therapy. Patients provided 2-year resource data, and 1-year symptom severity scores. A within-trial cost effectiveness analysis was conducted from a British health service perspective.


RESULTS
Significant reductions in resource use occurred comparing eradication with placebo. After 2 years, PPI prescriptions (full-dose equivalents) fell by 3.9 (P < 0.0001); clinician (GP) consultations by 2.4 (P = 0.0001); upper gastrointestinal (GI) endoscopies by 14.8% (P = 0.008); clinician GI-related home visits by 19.9% (P = 0.005) and abdominal ultrasound scans fell by 20.3% (P = 0.005). Average net savings/patient were pound93 (95% CI: 33-153) after costs of detection and eradication had been deducted. At 1 year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (P = 0.005) and quality-of-life measures improved (EuroQol-5D: 0.089, P = 0.08; visual analogue scale: 5.6, P = 0.002) favouring eradication.


CONCLUSIONS
Helicobacter pylori eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and symptom severity.
Mason
J M
JM
School of Medicine and Health, Durham University, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, UK. j.m.mason@durham.ac.uk
Raghunath
A S
AS
Hungin
A P S
AP
Jackson
W
W
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000191:economics* / Q000627:therapeutic use; D000658:Amoxicillin / Q000191:economics* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D017291:Clarithromycin / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D004415:Dyspepsia / Q000188:drug therapy / Q000191:economics; D005500:Follow-Up Studies; D017048:Health Care Costs; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016480:Helicobacter pylori; D006801:Humans; D064747:Lansoprazole; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D016896:Treatment Outcome; D006113:United Kingdom
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D000658:Amoxicillin; D017291:Clarithromycin