Sonnenberg A, Townsend W F
Department of Medicine, Veterans Affairs Medical Center, Milwaukee, USA.
Arch Intern Med. 1995 May 8;155(9):922-8.
Intermittent or maintenance therapy with histamine2 antagonists, highly selective vagotomy, or antibiotic therapy to eradicate Helicobacter pylori all represent distinct, viable options to manage duodenal ulcer disease. Comparing the costs associated with these four approaches could help in deciding among them.
The decision model of a Markov chain was used to compare the costs of the four approaches and their influence on the natural course of duodenal ulcers. Direct costs were calculated from the average wholesale prices of drugs and from charges for medical services submitted to and allowed by the Health Care Financing Administration. Average annual income was used to estimate indirect costs.
The model predicted that after antibiotic therapy, 99.7% of patient time is spent free of duodenal ulcer. The corresponding percentages were 96.6% for maintenance therapy, 94.4% for vagotomy, 89.4% for intermittent therapy, and 82.8% without therapy. For an individual patient after 15 years, the expected total costs of a treatment approach involving antibiotics are $995, compared with $10,350 for intermittent therapy with histamine2 antagonists, $11,186 for maintenance therapy with histamine2 antagonists, and $17,661 after vagotomy. Incorporating upper gastrointestinal tract endoscopy to verify eradication of H pylori raises the costs of the antibiotic therapy option to $2426. Increasing the annual infection rate of H pylori from baseline 1% to 10% raises the expected costs after 15 years to $3431. Decreasing the H pylori eradication rate from baseline 80% to 50% raises the costs to $2679.
Compared with other options, antibiotics to eradicate H pylori are the cheapest therapy for duodenal ulcer and provide the least time spent with an active ulcer. From an economic perspective, antibiotics represent the treatment of choice.
使用组胺2拮抗剂进行间歇性或维持性治疗、高选择性迷走神经切断术或抗生素疗法根除幽门螺杆菌，均是治疗十二指肠溃疡疾病的不同但可行的选择。比较这四种方法的成本有助于在它们之间做出决策。
采用马尔可夫链决策模型来比较这四种方法的成本及其对十二指肠溃疡自然病程的影响。直接成本根据药品平均批发价格以及提交给医疗保健财务管理局并获其批准的医疗服务费用计算得出。使用平均年收入来估算间接成本。
该模型预测，抗生素治疗后，99.7%的患者时间处于无十二指肠溃疡状态。维持性治疗的相应百分比为96.6%，迷走神经切断术为94.4%，间歇性治疗为89.4%，未治疗为82.8%。对于一名个体患者，15年后，涉及抗生素的治疗方法的预期总成本为995美元，而使用组胺2拮抗剂进行间歇性治疗的成本为10350美元，使用组胺2拮抗剂进行维持性治疗的成本为11186美元，迷走神经切断术后的成本为17661美元。纳入上消化道内镜检查以验证幽门螺杆菌的根除会使抗生素治疗方案的成本升至2426美元。将幽门螺杆菌的年感染率从基线的1%提高到10%会使15年后的预期成本升至3431美元。将幽门螺杆菌的根除率从基线的80%降至50%会使成本升至2679美元。
与其他选择相比，根除幽门螺杆菌的抗生素是治疗十二指肠溃疡最便宜的疗法，且溃疡活动期的时间花费最少。从经济角度来看，抗生素是首选治疗方法。
