Sonnenberg A
Department of Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.
Pharmacoeconomics. 1998 Oct;14(4):423-32. doi: 10.2165/00019053-199814040-00008.
Conflicting recommendations have been made on whom to treat with antibacterials to eradicate Helicobacter pylori. The present analysis aims to explain the basis of such discrepancies.
The decision in favour of or against antibacterial therapy in patients with upper gastrointestinal symptoms is modelled as a threshold analysis. The threshold is the lowest probability for a given diagnosis at which the decision in favour of antibacterial therapy yields a higher expected outcome than the decision against it. A strong indication for antibacterial therapy is shown by a low threshold value.
In patients with suspected peptic ulcer disease, both the high success rate of antibacterial therapy and its low cost make it the most favourable treatment option, its threshold being less than 35%. In ulcer patients receiving nonsteroidal anti-inflammatory drugs, the threshold is 73% if based on success rates of different treatment modalities, but only 7% if treatment costs are considered. The relatively poor success rate of antibacterial therapy in non-ulcer dyspepsia raises the diagnostic threshold for antibacterial therapy to 76% if based on therapeutic success rates. The small marginal cost of antibacterial therapy lowers the diagnostic threshold to 16%.
If therapeutic success is the primary concern, patients with vague abdominal symptoms should not be given antibacterial therapy, unless H. pylori has been established as a probable cause of their symptoms. If healthcare costs are the driving force for choosing one type of therapy over another, a trial of antibacterials appears indicated irrespective of any firm validation of H. pylori playing a role in the patient's disease.
关于使用抗菌药物根除幽门螺杆菌的治疗对象，已出现相互矛盾的建议。本分析旨在解释此类差异产生的原因。
将针对有上消化道症状患者是否进行抗菌治疗的决策建模为阈值分析。该阈值是指对于给定诊断，支持抗菌治疗的决策比反对该治疗的决策产生更高预期结果的最低概率。较低的阈值表明抗菌治疗有强烈指征。
在疑似消化性溃疡病患者中，抗菌治疗的高成功率及其低成本使其成为最有利的治疗选择，其阈值低于35%。在接受非甾体抗炎药治疗的溃疡患者中，若基于不同治疗方式的成功率，阈值为73%，但考虑治疗成本时，阈值仅为7%。抗菌治疗在非溃疡性消化不良患者中的成功率相对较低，若基于治疗成功率，抗菌治疗的诊断阈值升至76%。抗菌治疗的边际成本较小，使诊断阈值降至16%。
如果主要关注治疗成功，对于有模糊腹部症状的患者，除非已确定幽门螺杆菌可能是其症状的病因，否则不应给予抗菌治疗。如果医疗成本是选择一种治疗方式而非另一种的驱动因素，那么无论幽门螺杆菌在患者疾病中发挥作用的任何确切验证情况如何，进行抗菌药物试验似乎都是合适的。
