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H. pylori: Cost effectiveness

H. pylori: Cost effectivenessCost effectiveness of screening for and eradication of Helicobacfer pylori in management of dyspeptic patients under 45 years of age. Briggs, A.H., Sculpher, M.J., Logan, R.P.H., Aldous, J., Ramsay, M.E. and Baron, J.H. BMJ, 312(7042): 1321-1325, 25 May 1996.

The authors used a decision analysis model to assess the cost effectiveness of screening for and eradicating Helicobacter pylori in patients under 45 years of age presenting to their GP with dyspepsia.

They found that:

•eradication treatment is cost effective for the treatment of confirmed peptic ulcer;

• patients under the age of 45 years presenting with peptic-type dyspepsia without sinister symptoms are usually managed empirically;

• only a minority of these patients will have peptic ulcer disease and Helicobacter pylori infection;

• identification of appropriate patients for Helicobacter pylori eradication treatment from among dyspeptic patients will entail considerable investment of resources;

• the cost savings associated with a reduction in use of H2 antagonists by patients who receive successful Helicobacter pylori eradication may take many years to materialize.

Varying efficacy of Helicobaeter pylori eradication regimens: cost effectiveness study using decision analysis model. Duggan, A.E., Tolley, K., Hawkey, C.J. and Logan, R.F.A. Department of Public Health and Epidemiology, University of Nottingham, Nottingham, UK. BMJ, 316(7145): 1648-1654, 30 May 1998.

This study uses decision analysis models to compare the cost effectiveness of different strategies for treating Helicobacter pylori ulcer disease. The omeprazole, clarithro-mycin and metronidazole regimen (eradication rate 91%) was compared with the omeprazole, amoxycillin and metronidazole regimen (eradication rate 85%). The authors also looked at cost and efficacy when l3C-urea breath testing was routinely added after treatment to confirm eradication.

• Without routine breath testing the most cost-effective model was omeprazole, clarithromycin and metronidazole.

• Further breath testing and a second course of therapy achieved the best eradication rates at 97%. However, this regimen was also the most expensive.

• The routine use of breath testing after treatment increased all costs, but reduced the advantage that the clarithromycin regimen had over the amoxycillin regimen.

The authors suggest that l3C-urea breath testing to identify those who fail eradication treatment will be cost effective only in high-risk patients. They point out that the indirect costs are not measured in this study, e.g. cost to the patient of making visits to the doctor, doctor time, quality of life, etc.

Others

ln-practice evaluation of whole-blood Helieobacter pylori test: its usefulness in detecting peptic ulcer disease. Quartero, A.O., Numans, M.E., De Melker, R.A. and De Wit, N.J. Department of General Practice, Utrecht University, The Netherlands. Br J Gen Pract, 50(450): 13-16, Jan. 2000.

About 170 patients presenting with dyspepsia were tested using the ‘BM-test for Helieobacter pylori” (Cortecs). They were then endoscoped at a local hospital where definitive tests were undertaken to establish their Helicobacter pylori status.

•The results show a high (62%) false negative BM-test for the detection of Helicobacter pylori. Only 12 of the 32 patients with active peptic ulcer disease had a positive BM-test. The study confirmed the relatively poor performance of the BM-test in daily general practice and highlighted the limited diagnostic value of Helicobacter pylori office tests for detecting peptic ulcer disease in general practice.

Further reading

Familial clustering of Helieobacter pylori infection: population based study. Dominici, P., Bellentani, S. and Di Base, A.R. et al. Medical Department, Bracco, Milan, Italy. BMJ, 319(7209): 537-541, 28 Aug. 1999.

Regular review. Treatment of Helieobacter pylori infection, de Boer, W.A. and Tytgat, G.N.J. Department of Internal Medicine, Saint Anna Hospital, The Netherlands. BMJ, 320(7226): 31-34, 1 Jan. 2000.

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