Cost-effectiveness of Helicobacter pylori eradication for the long-term management of duodenal ulcer in Canada.

BACKGROUND A 1994 National Institutes of Health consensus panel recommended that eradication of Helicobacter pylori should be first-line therapy for persons with duodenal ulcer. OBJECTIVE To assess the cost-effectiveness of H pylori eradication relative to alternative pharmacologic strategies in the long-term management of persons with confirmed duodenal ulcer. METHODS Decision analysis model to estimate expected costs and symptomatic ulcer recurrences during a 12-month period for three general treatment strategies: (1) immediate H pylori eradication; (2) H pylori eradication at first ulcer recurrence; and (3) continuous maintenance therapy with a histamine2 receptor antagonist (ranitidine hydrochloride). Two H pylori eradication therapies were compared: classic triple therapy and omeprazole plus amoxicillin. Probabilities for ulcer recurrence are by meta-analysis of published randomized trials. Health care resources used in the management of duodenal ulcer recurrence were by expert physician panel. All costs are in 1993 Canadian dollars. RESULTS Duodenal ulcer recurrence at 6 months (symptomatic and asymptomatic) with placebo was 65.4% and 12.8% with maintenance ranitidine therapy. Where eradication of H pylori was successful (85% of patients), the ulcer recurrence rate to 12 months was 3.7%. Treatment with ranitidine and triple therapy to eradicate H pylori on first presentation has an expected 1-year cost of $253 with 15 symptomatic recurrences per 100 patients; H pylori eradication by omeprazole plus amoxicillin had similar expected costs ($272) and outcomes (15 recurrences per 100 patients). Both of these early H pylori eradication strategies were dominant (less costly with same or better outcomes) over intermittent or continuous maintenance ranitidine therapy or delayed (after first recurrence) H pylori eradication. CONCLUSION Our analysis provides economic evidence in support of the recent guidance that for persons with duodenal ulcer, early attempts to eradicate H pylori are recommended.