Pharmacoeconomic comparison of Helicobacter pylori eradication regimens
- 126 Downloads
Helicobacter pylori is the most important etiologic agent for development of peptic ulcer, chronic gastritis and gastric carcinomas. It is now well established that H. pylori eradication treatment is more cost-effective than acid suppressing therapies alone for the treatment of peptic ulcer disease. However, the comparative cost-effectiveness of various H. pylori eradication regimens is still not clear.
This study was designed to make a pharmacoeconomic comparison of different H. pylori eradication regimens in patients with peptic ulcer disease or chronic gastritis, using real-world cost and effectiveness data.
Istanbul University Hospital and Marmara University Hospital.
A total of 75 patients diagnosed as H. pylori (+) by endoscopy were randomized to receive one of the seven H. pylori treatment protocols. These protocols were as follows: (LAC) = ‘lansoprazole 30 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’ for 7 days and (OCM) = ‘omeprazole 20 mg bid + clarithromycin 250 mg bid + metronidazole 500 mg bid’; (OAM) = ‘omeprazole 40 mg qd + amoxicillin 500 mg tid + metronidazole 500 mg tid’; (MARB) = ‘metronidazole 250 mg tid + amoxicillin 500 mg qid + ranitidine 300 mg hs + bismuth 300 mg qid’; (OAC) = omeprazole 20 mg bid + amoxicillin 1 g bid + clarithromycin 500 mg bid’; (OCA) = omeprazole 40 mg bid + clarithromycin 500 mg bid + amoxicillin 1 g bid’; (OAB) = ‘omeprazole 20 mg bid + amoxicillin 500 mg tid + bismuth 300 mg qid’ each for 14 days. Only direct costs were included in the analysis. Effectiveness was measured in terms of “successful eradication”. The cost-effectiveness ratios of the regimens were calculated using these effectiveness and cost data. The perspective of the study was assumed as the Government’s perspective.
Main outcome measure
Cost-effectiveness ratios of eradication regimens.
MARB and OCA regimens were found to be more cost-effective than the other treatment regimens. The eradication rates and cost-effectiveness ratios calculated for these protocols were 90% (€158.7) for MARB and 90% (€195.8) for OCA regimen.
This study confirms the importance of using local pharmacoeconomic data. Analyses such as this give decision-makers the tools to choose a better treatment option which is both highly effective yet and has a low cost.
KeywordsCost-effectiveness Eradication regimens Gastritis Helicobacter pylori Peptic ulcer Pharmacoeconomics
Unable to display preview. Download preview PDF.
The authors would like to thank the pharmaceutical firms Abfar, Deva, Eczacibasi, I.E.Ulagay, Ilsan-Iltas and Toprak for supplying the drugs used for this project.
Conflicts of interest: none declared.
- 2.Veldhuyzen SO, Sherman PM, Hunt RH. Helicobacter pylori: new developments and treatments. Can Med Assoc J 1997;156:1565–72Google Scholar
- 4.Van Der Weyden MB, Armstrong RM, Gregory AT. The 2005 Nobel Prize in physiology or medicine. The Helicobacter story illustrates some of the human hallmarks of revolutionary research. Med J Aust 2005;183:612–4Google Scholar
- 31.Jönsson B. Cost-effectiveness of Helicobacter pylori eradication therapy in duodenal ulcer disease. Scand J Gastroenterol 1996;31(Suppl. 215):90–5Google Scholar
- 33.Clifton S, Galt K. Treatment of Helicobacter pylori infection. Immanuel Medical Center Pharmacy Memo 1997Google Scholar
- 34.Eralp Y, Davutoglu C, Uzunismail H, Oktay E. Efficacy of combination therapy with omeprazole, amoxicillin and clarithromycin treatment of patients with Helicobacter pylori associated gastritis and duodenal ulcer disease. Turk J Gastroenterol 1999;10:27–31Google Scholar
- 35.Unge P. Review of H. pylori eradication regimens. Scand J Gastroenterol 1996;31(Suppl. 2):74–81Google Scholar
- 36.Cutler AF, Vakil N. Evolving therapy for Helicobacter pylori infection: efficacy and economic impact in the treatment of patients with duodenal ulcer disease. Am J Man Care 1997;3:1528–34Google Scholar