What is the optimal length of proton pump inhibitor-based triple therapies for H. pylori? A cost-effectiveness analysis

Aliment Pharmacol Ther. 2001 Jul;15(7):1067-76. doi: 10.1046/j.1365-2036.2001.01031.x.


Background: Triple therapy with a proton pump inhibitor, clarithromycin and amoxicillin is widely used for H. pylori infection. The appropriate length of treatment remains controversial.

Aim: To determine whether length of treatment has an impact on the cost-effectiveness of triple therapy.

Methods: The study took the form of a cost-effectiveness analysis spanning 2 years. The perspective was societal and the setting, ambulatory care. Subjects were Helicobacter pylori-positive patients with a duodenal ulcer. The triple therapy trials spanned 7, 10 or 14 days and the main outcome measures were cost per patient and marginal cost for additional cured patient calculated for a low cost-of-care setting (Spain), for a high-cost setting (USA), and for two follow-up strategies: (i) systematic 13C-urea breath test after eradication; (ii) clinical follow-up, breath-test if symptoms recurred.

Results: Base-case analysis showed that for both the 13C-UBT and the clinical follow-up branches, lowest costs were obtained with 7-day schedules both in Spain and the USA. Sensitivity analysis showed that in Spain, 10-day therapies would have to increase 7-day cure rates by 10-12% to become cost-effective. In contrast, in the USA only a 3-5% increase was needed. The corresponding figures for 14-day therapy were 25-35% and 8-11%, respectively.

Conclusions: Seven-day therapies seem the most cost-effective strategy. However, in high-cost areas the differences were less evident.

MeSH terms

  • Amoxicillin / administration & dosage*
  • Amoxicillin / economics
  • Amoxicillin / pharmacology
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / pharmacology
  • Anti-Ulcer Agents / administration & dosage*
  • Anti-Ulcer Agents / economics
  • Anti-Ulcer Agents / pharmacology
  • Breath Tests
  • Carbon Isotopes
  • Clarithromycin / administration & dosage*
  • Clarithromycin / economics
  • Clarithromycin / pharmacology
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Drug Administration Schedule
  • Drug Costs
  • Duodenal Ulcer / drug therapy*
  • Duodenal Ulcer / microbiology
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / pathogenicity
  • Humans
  • Penicillins / administration & dosage*
  • Penicillins / economics
  • Penicillins / pharmacology
  • Proton Pump Inhibitors*
  • Proton Pumps / economics
  • Treatment Outcome
  • Urea / analysis


  • Anti-Bacterial Agents
  • Anti-Ulcer Agents
  • Carbon Isotopes
  • Penicillins
  • Proton Pump Inhibitors
  • Proton Pumps
  • Amoxicillin
  • Urea
  • Clarithromycin