幽门螺杆菌根除策略治疗消化性溃疡疾病的经济和健康影响：成本效益分析。

Economic and health impacts of Helicobacter pylori eradication strategy for the treatment of peptic ulcer disease: A cost-effectiveness analysis.

机构信息

Advanced Research Promotion Center, Health Sciences University of Hokkaido, Ishikari-gun, Japan.

Department of Occupational Health, Kitasato University Graduate School of Medical Sciences, Kanagawa, Japan.

出版信息

Helicobacter. 2022 Jun;27(3):e12886. doi: 10.1111/hel.12886. Epub 2022 Mar 27.

DOI:10.1111/hel.12886

PMID:35343031

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9286595/

Abstract

BACKGROUND

Most peptic ulcer cases are associated with Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori eradication therapy is recommended for the treatment of H. pylori-positive peptic ulcers. We aimed to assess and validate the cumulative economic and health effects of H. pylori eradication strategy for the treatment of peptic ulcers compared with PPI therapy strategy.

MATERIALS AND METHODS

We developed a cohort state-transition model for H. pylori eradication strategy and PPI therapy strategy over a lifetime horizon from a healthcare payer perspective. We targeted two hypothetical cohorts of H. pylori-positive patients with gastric and duodenal ulcers aged 20, 30, 40, 50, 60, 70, and 80. The main outcomes were costs, quality-adjusted life-years (QALYs), life expectancy life-years (LYs), incremental cost-effectiveness ratios, ulcer recurrence cases, and ulcer-associated deaths. One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty.

RESULTS

In the base-case analysis, H. pylori eradication strategy was less costly with greater benefits than PPI therapy strategy in all age groups. Cost-effectiveness was not sensitive to any variables in all age groups. Sensitivity analyses showed strong robustness of the results. From 2000 to 2020, H. pylori eradication strategy saved US$14.07 billion over a lifetime, increased 8.65 million QALYs and 1.23 million LYs over a lifetime, and prevented 551,298 ulcer recurrence cases and 59,465 ulcer-associated deaths, compared with PPI therapy strategy.

CONCLUSIONS

H. pylori eradication strategy not only has contributed significantly to preventing ulcer recurrence and reducing ulcer-associated deaths but also has resulted in great cost savings. All over the world, H. pylori eradication strategy is likely to have yielded a comparable magnitude of economic and health benefits, depending on the epidemiology of H. pylori-related peptic ulcers and the healthcare environment in each country.

摘要

背景

大多数消化性溃疡与幽门螺杆菌（H. pylori）感染或非甾体抗炎药（NSAIDs）的使用有关。对于 H. pylori 阳性消化性溃疡，建议采用 H. pylori 根除疗法进行治疗。我们旨在评估和验证与 PPI 治疗策略相比，H. pylori 根除策略治疗消化性溃疡的累积经济和健康效果。

材料和方法

我们从医疗保健支付者的角度，针对 H. pylori 根除策略和 PPI 治疗策略，开发了一个终生队列状态转换模型。我们针对两个具有胃和十二指肠溃疡的 H. pylori 阳性患者假设队列，年龄分别为 20、30、40、50、60、70 和 80 岁。主要结果是成本、质量调整生命年（QALYs）、预期寿命生命年（LYs）、增量成本效益比、溃疡复发病例和溃疡相关死亡。进行了单因素和概率敏感性分析，以评估不确定性的影响。

结果

在基本分析中，在所有年龄段中，H. pylori 根除策略的成本较低，而 PPI 治疗策略的获益更高。在所有年龄段中，成本效益均不受任何变量的影响。敏感性分析表明结果具有很强的稳健性。从 2000 年到 2020 年，与 PPI 治疗策略相比，H. pylori 根除策略在一生中节省了 140.7 亿美元，增加了 865 万个 QALYs 和 123 万个 LYs，并预防了 551298 例溃疡复发和 59465 例溃疡相关死亡。