Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost-effective: economic analysis of the HELPUP trial

Aliment Pharmacol Ther. 2008 Dec 1;28(11-12):1297-303. doi: 10.1111/j.1365-2036.2008.03851.x. Epub 2008 Sep 14.

Abstract

Background: Proton pump inhibitor (PPI) use is costly and about two-thirds of prescribing is long-term. Although 20-50% of patients may be infected with Helicobacter pylori, eradication is not normal clinical practice.

Aim: To establish if H. pylori eradication in long-term PPI users is cost-effective.

Methods: Long-term PPI-using patients (n = 183) testing positive for H. pylori were randomly assigned to true or placebo eradication therapy. Patients provided 2-year resource data, and 1-year symptom severity scores. A within-trial cost effectiveness analysis was conducted from a British health service perspective.

Results: Significant reductions in resource use occurred comparing eradication with placebo. After 2 years, PPI prescriptions (full-dose equivalents) fell by 3.9 (P < 0.0001); clinician (GP) consultations by 2.4 (P = 0.0001); upper gastrointestinal (GI) endoscopies by 14.8% (P = 0.008); clinician GI-related home visits by 19.9% (P = 0.005) and abdominal ultrasound scans fell by 20.3% (P = 0.005). Average net savings/patient were pound93 (95% CI: 33-153) after costs of detection and eradication had been deducted. At 1 year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (P = 0.005) and quality-of-life measures improved (EuroQol-5D: 0.089, P = 0.08; visual analogue scale: 5.6, P = 0.002) favouring eradication.

Conclusion: Helicobacter pylori eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and symptom severity.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 2-Pyridinylmethylsulfinylbenzimidazoles / economics*
  • 2-Pyridinylmethylsulfinylbenzimidazoles / therapeutic use
  • Amoxicillin / economics*
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use*
  • Clarithromycin / economics*
  • Clarithromycin / therapeutic use
  • Cost-Benefit Analysis
  • Double-Blind Method
  • Drug Costs
  • Dyspepsia / drug therapy
  • Dyspepsia / economics
  • Follow-Up Studies
  • Health Care Costs
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / economics*
  • Helicobacter pylori*
  • Humans
  • Lansoprazole
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / therapeutic use*
  • Quality of Life
  • Treatment Outcome
  • United Kingdom

Substances

  • 2-Pyridinylmethylsulfinylbenzimidazoles
  • Anti-Bacterial Agents
  • Proton Pump Inhibitors
  • Lansoprazole
  • Amoxicillin
  • Clarithromycin