Cost-Effectiveness of Abbreviated Regimens for Helicobacter pylori Eradication in Peptic Ulcer Disease

• Objective: To compare the cost-effectiveness of abbreviated and conventional regimens for eradicating Helicobacter pylori infection in the treatment of peptic ulcer disease (PUD). • Design: Cost-effectiveness analysis. • Patients: Hypothetical cohort of persons with a diagnosis of PUD. • Methods: A decision analytic model using the thirdparty payer perspective was created. Three abbreviated regimens (lansoprazole, azithromycin, and metronidazole [LAM]; omeprazole, clarithromycin, and metronidazole [OCM]; and bismuth, metronidazole, tetracycline, and omeprazole [BMT-O]) were compared to 3 regimens approved by the Food and Drug Administration (dual therapy with omeprazole and clarithromycin [OC]; triple therapy with lansoprazole, clarithromycin, and amoxicillin [LCA]; and quadruple therapy with bismuth, metronidazole, tetracycline, and famotidine [BMT-H2RA]). Parameter estimates (compliance, eradication, and ulcer recurrence) were based on published meta-analyses, clinical trials, and review data. Average wholesale price was used for regimen costs. Effectiveness, based upon ulcer cure probability, was estimated using a clinician survey. • Measurements: Expected incremental costs, effectiveness (ulcer cure rate), average cost-effectiveness, and incremental cost-effectiveness. • Results: Expected costs ranged from $157 (BMT-O) to $436 (OC). Effectiveness was high in all regimens, ranging from 83% (OC) to 89% (BMT-O and OCM). BMT-O had the lowest average cost-effectiveness ratio ($176 per ulcer cured), dominating all regimens in incremental analysis. Sensitivity analyses demonstrated LAM’s potential to surpass BMT-O in cost-effectiveness following subtle changes in eradication (∆ 3%) and compliance (∆ 7%) rates and average wholesale price (∆ 10%–11%). • Conclusions: Abbreviated H. pylori eradication regimens warrant evaluation as potential treatments with effectiveness similar to conventional regimens and possible cost savings.