Cost-effectiveness of Helicobacter pylori eradication therapy in duodenal ulcer disease.

A model analysis applied to Helicobacter pylori eradication found that, following successful healing with omeprazole and H. pylori eradication, virtually all patients were cured and experienced no relapse during the next 5 years. In contrast, almost all of the patients receiving episodic therapy relapsed and, during maintenance therapy with H2-receptor antagonists, most experienced at least one relapse. Although H. pylori eradication initially resulted in higher costs than the alternative therapies, it reduced the risk of recurrence and, for most patients, no future costs were incurred. Even with a worst case scenario, such as an H. pylori eradication rate of only 50%, the H. pylori eradication therapy had a pay-off period of less than 1.3 years compared with maintenance treatment and 3 years compared with episodic treatment. A preliminary analysis also compared the cost-effectiveness of three different H. pylori eradication therapies: omeprazole plus one or two antibiotics, ranitidine plus two antibiotics, and ranitidine plus bismuth triple therapy. The highest eradication rates (in excess of 90%) were achieved using 1-week regimens including omeprazole in combination with either clarithromycin or amoxycillin and a nitroimidazole. These regimens were also shown to be the most cost-effective. As the difference in costs between the therapies is small compared with the savings that can be achieved by successful H. pylori eradication, it is logical that the eradication strategy with the highest eradication rate is the most cost-effective. The model analysis concludes that H. pylori eradication in patients with duodenal ulcer disease is cost-effective in comparison to episodic therapy with omeprazole or maintenance therapy with ranitidine.