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Pharmacoeconomic Comparison of Treatments for the Eradication of Helicobacter pylori

Jennifer L. Taylor; Martin Zagari, MD; Karen Murphy; James W. Freston, MD, PhD
Arch Intern Med. 1997;157(1):87-97. doi:10.1001/archinte.1997.00440220091012.
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Background:  Patients with Helicobacter pylori— induced duodenal ulcer should have their infection eradicated. The optimal choice of antibiotic therapy, however, is less clear.

Objective:  To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine2receptor antagonists (H2RA).

Methods:  A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates. The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness. A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes.

Results:  Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients. The H2RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence).

Conclusion:  Treatment with any regimen resulted in lower costs compared with H2RA maintenance therapy. Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days.Arch Intern Med. 1997;157:87-97


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