What is the best strategy for diagnosis and treatment of helicobacter pylori in the prevention of recurrent peptic ulcer bleeding? A cost-effectiveness analysis

Emili Gené, Jordi Sanchez-Delgado, Xavier Calvet, Javier P. Gisbert, Rafel Azagra

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

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. © 2009, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Original languageEnglish
Pages (from-to)759-762
JournalValue in Health
Volume12
Issue number5
DOIs
Publication statusPublished - 1 Jan 2009

Keywords

  • Bleeding peptic ulcer
  • Cost-effectiveness
  • Helicobacter pylori
  • Prevention
  • Treatment

Fingerprint Dive into the research topics of 'What is the best strategy for diagnosis and treatment of helicobacter pylori in the prevention of recurrent peptic ulcer bleeding? A cost-effectiveness analysis'. Together they form a unique fingerprint.

Cite this