Seven days or ten? Cost-effectiveness study on the duration of H pylori treatment in primary care

Objective. To determine through an economic evaluation study whether it is cost-effective to extend treatment of dyspeptic patients from 7 to 10 days, distinguishing between functional dyspepsia, unexamined dyspepsia, and ulcer disease. Design. Cost-effectiveness study by means of a decision 3 comparing direct costs per patient cured with 2 strategies: a) 7 days treatment versus b) 10 days. Two-year study in the National Health System. Setting. Primary care. Participants. One-hundred patients with peptic ulcer, functional dyspepsia, or unexamined dyspepsia who received treatment for H pylori infection. Interventions. H pylori eradication treatment with a proton pump inhibitor, clarithromycin, and amoxycillin for 7 or 10 days. Measurement variable: incremental cost per patient cured. Results. In peptic ulcer patients, the incremental cost per patient cured on extending the eradication treatment from 7 to 10 days was €147 (95% CI, 121.3-162.7), whereas in patients with functional or unexamined dyspepsia, it was -€39.8 (95% CI, -28.5 to -60.7) and -€27.3 (95% CI, -14.92 to -52.72), respectively. The sensitivity analysis showed that the efficacy of eradication treatment (7 vs 10) was the factor that most affected the stability of the results. Conclusions. Seven days is the most cost-effective duration of the triple therapy for eradicating H pylori in ulcer patients. However, 10 days is more cost-effective in functional dyspepsia patients or those with no prior endoscope diagnosis.