Gomollón F, Valdepérez J, Garuz R, Fuentes J, Barrera F, Malo J, Tirado M, Simón M A
Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza.
Med Clin (Barc). 2000 Jun 3;115(1):1-6. doi: 10.1016/s0025-7753(00)71447-3.
To analyze cost-effectiveness of two different strategies to treat H. pylori infection in peptic ulcer in the primary care setting.
Consecutive patients with endoscopic diagnosis of peptic ulcer were randomized to one of two strategies: a) treatment during 7 days with omeprazole, tetracycline, metronidazole and bismuth subcitrate ("quadruple" therapy) and if failure second-line treatment with omeprazole, amoxycillin and clarithromycin during 7 days (OCA7), and b) initial treatment with OCA7 and if failure treatment with "quadruple therapy". End point was eradication 8 weeks after last treatment dose. Direct and indirect costs were estimated (euros, 1997) and a cost-effectiveness analysis using a decision-tree model was undertaken after real clinical data. 95% confidence intervals are given.
After screening 255 patients, 97 were finally included. 48 patients were given strategy a and 49 strategy b. Eradication was obtained (intention-to-treat) in 72.9% (CI 95%: 58.2-84.7) in group a versus 91.8% (CI 95%: 80.4-97.7) (p < 0.05) in group b. Mean cost per case treated was lower in group a (237 versus 268 euros) but cost per case eradicated was lower in group b (320 versus 296 euros). The cost was primarily determined by efficacy.
Treatment with OCA7 followed by rescue with "quadruple" therapy if failure is more efficient in our area that the inverse strategy. Efficiency is mostly determined by efficacy.
分析在基层医疗环境中治疗消化性溃疡幽门螺杆菌感染的两种不同策略的成本效益。
经内镜诊断为消化性溃疡的连续患者被随机分为两种策略之一：a）使用奥美拉唑、四环素、甲硝唑和枸橼酸铋钾进行7天治疗（“四联”疗法），若治疗失败则在7天内使用奥美拉唑、阿莫西林和克拉霉素进行二线治疗（OCA7）；b）初始使用OCA7治疗，若治疗失败则使用“四联疗法”。终点为最后一剂治疗后8周的根除情况。估算了直接和间接成本（1997年欧元），并根据实际临床数据使用决策树模型进行了成本效益分析。给出了95%置信区间。
在筛查255例患者后，最终纳入97例。48例患者采用策略a，49例采用策略b。a组的根除率（意向性治疗）为72.9%（95%CI：58.2 - 84.7），b组为91.8%（95%CI：80.4 - 97.7）（p < 0.05）。a组每例治疗的平均成本较低（237欧元对268欧元），但b组每例根除的成本较低（320欧元对296欧元）。成本主要由疗效决定。
在我们地区，先使用OCA7治疗，若失败则采用“四联疗法”挽救的策略比相反策略更有效。效率主要由疗效决定。
