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[A cost-effectiveness analysis of strategies for the diagnosis-treatment of Helicobacter pylori-associated peptic ulcer in primary care].

OBJECTIVES
To undertake an economic evaluation of three strategies for diagnosing and treating Helicobacter pylori (HP)-related peptic ulcers (PU), and to find the most efficacious and efficient combination of medication for the most cost-effective strategy.


DESIGN
Cost-effectiveness analysis based on retrospective information (systematic review of the literature) and Markov models for the simulation of a hypothetical cohort of patients with PU.


PATIENTS
Patients seeking medical care at the primary level for an acute PU attack. The costs and health effects of the management of an attack were evaluated in a hypothetical cohort of adults (> 18 years old) with symptomatic peptic ulcer confirmed endoscopically and not associated with consumption of non-steroidal anti-inflammatory drugs (NSAIDs).


INTERVENTIONS
Three strategies for handling PU patients were compared: pre- and post-treatment diagnosis of HP, pre-treatment diagnosis and empirical treatment. Then the most efficient strategy for comparing 6 combinations of antibiotics was used.


RESULTS
The empirical treatment strategy was markedly less costly (saving of between 15000 and 39000 pesetas per patient treated) than the diagnosis strategies, and obtained equivalent effectiveness under all analytical hypotheses. In comparing drug combinations, the classic triple therapies based on bismuth subcitrate were more effective and less costly than other therapies.


CONCLUSIONS
Empirical treatment with combinations of irradicatory drugs was the most efficient strategy for tackling the diagnosis/therapy of patients with HP-related PU. In terms of efficiency, the choice between the various combinations of irradicatory drugs with over 80% success depends basically on the cost of the drugs.