What Is the Best Strategy for Diagnosis and Treatment of Helicobacter Pylori in the Prevention of Recurrent Peptic Ulcer Bleeding? A Cost-Effectiveness Analysis

Value Health. Jul-Aug 2009;12(5):759-62. doi: 10.1111/j.1524-4733.2009.00524.x.

Abstract

Background: Clinical trials provide evidence of the high effectiveness of Helicobacter pylori eradication for preventing recurrent ulcer-related gastrointestinal hemorrhage. The best strategy for curing the infection in this setting is, however, still under debate.

Objective: To evaluate four different strategies for prevention of rebleeding in patients with peptic ulcer hemorrhage: 1) test for H. pylori and treatment, if positive; 2) proton pump inhibitor maintenance; 3) no preventive treatment; 4) empirical H. pylori eradication immediately after bleeding.

Methods: A decision analysis model was used, with a time horizon of 2 years and a third-party payer perspective. Costs were estimated for two different settings: a low-cost-for-care area (Spain) and a high-cost area (USA). Main outcome measure was incremental cost-effectiveness ratio for each upper gastrointestinal hemorrhage avoided.

Results: Empirical H. pylori eradication was the dominant strategy: its estimated rate of recurrent bleeding was lower (6.1%) than those of strategies 1 (7.4%), 2 (11.1%), and 3 (18.4%) and it was the least expensive strategy. The results remained stable when variables were changed inside a wide range of plausible values. Sensitivity analysis also showed that the prevalence of H. pylori in bleeding ulcer was the variable that most influenced the results: when it was below 45% in Spain or below 51% in the United States, empirical eradication was not a dominant strategy although it remained cost-effective.

Conclusion: In patients with bleeding peptic ulcer, empirical treatment of H. pylori infection immediately after feeding is restarted is the most cost-effective strategy for preventing recurrent hemorrhage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost-Benefit Analysis
  • Decision Trees
  • Drug Costs
  • Health Care Costs
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / drug therapy
  • Helicobacter Infections / economics*
  • Helicobacter pylori*
  • Humans
  • Peptic Ulcer Hemorrhage / economics
  • Peptic Ulcer Hemorrhage / prevention & control*
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / therapeutic use
  • Secondary Prevention

Substances

  • Proton Pump Inhibitors