对既往有消化性溃疡病史患者立即根除幽门螺杆菌：临床及经济影响

Immediate eradication of Helicobacter pylori in patients with previously documented peptic ulcer disease: clinical and economic effects.

作者信息

Fendrick A M, McCort J T, Chernew M E, Hirth R A, Patel C, Bloom B S

机构信息

Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor 48109-0376, USA.

出版信息

Am J Gastroenterol. 1997 Nov;92(11):2017-24.

PMID:9362183

Abstract

OBJECTIVES

The clinical and economic benefits of Helicobacter pylori eradication for patients with newly diagnosed peptic ulcer disease are widely accepted. The objective of this study was to estimate the cost-effectiveness of H. pylori eradication in the large cohort of asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer disease.

METHODS

A decision analytic model estimated the clinical and economic effects of two management strategies for asymptomatic patients receiving maintenance antisecretory therapy for a previously documented peptic ulcer: strategy 1-immediate H. pylori eradication therapy and cessation of maintenance therapy, and strategy 2-continued-maintenance antisecretory therapy, with H. pylori eradication therapy reserved for the first symptom recurrence.

RESULTS

At 1 yr, the model estimated that immediate H. pylori eradication therapy (strategy 1) led to 22% fewer months with ulcers (28.7 vs. 36.8 ulcer months/100 patient years), 10% fewer months with ulcer symptoms (21.0 vs. 23.1 symptom months/100 patient years), and 24% lower per-patient expenditures ($587 vs. $767/patient year) than maintenance antisecretory therapy and symptom-based H. pylori eradication (strategy 2). Immediate H. pylori eradication, however, resulted in 14% more months with upper gastrointestinal symptoms from all causes (37.9 vs. 33.2 symptom months/100 patient years) than strategy 2, because maintenance antisecretory therapy was effective in treating symptoms due to causes other than peptic ulcer disease.

CONCLUSIONS

Ulcer-related outcomes of asymptomatic patients receiving maintenance antisecretory agents for peptic ulcer disease can be improved with immediate H. pylori eradication at reduced cost. Therefore, H. pylori eradication should be aggressively pursued in all patients-symptomatic or not-with previously documented peptic ulcers, who are receiving maintenance antisecretory therapy.

摘要

目的

幽门螺杆菌根除治疗对新诊断消化性溃疡病患者的临床和经济效益已得到广泛认可。本研究的目的是评估在大量因既往有消化性溃疡病而接受维持性抗分泌治疗的无症状患者中，根除幽门螺杆菌的成本效益。

方法

采用决策分析模型评估两种管理策略对因既往有消化性溃疡而接受维持性抗分泌治疗的无症状患者的临床和经济影响：策略1——立即进行幽门螺杆菌根除治疗并停止维持治疗，策略2——继续维持性抗分泌治疗，幽门螺杆菌根除治疗留待首次症状复发时进行。

结果

在1年时，模型估计立即进行幽门螺杆菌根除治疗（策略1）导致溃疡月数减少22%（28.7个溃疡月/100患者年 vs. 36.8个溃疡月/100患者年），溃疡症状月数减少10%（21.0个症状月/100患者年 vs. 23.1个症状月/100患者年），且每位患者的支出降低24%（587美元/患者年 vs. 767美元/患者年），优于维持性抗分泌治疗和基于症状的幽门螺杆菌根除治疗（策略2）。然而，与策略2相比，立即进行幽门螺杆菌根除治疗导致所有原因引起的上消化道症状月数增加14%（37.9个症状月/100患者年 vs. 33.2个症状月/100患者年），因为维持性抗分泌治疗对治疗除消化性溃疡病以外原因引起的症状有效。