Varying efficacy of Helicobacter pylori eradication regimens: cost effectiveness study using a decision analysis model

British Medical Journal, May 30, 1998 by A.E. Duggan, K. Tolley, C.J. Hawkey, R.F.A. Logan

To reflect how clinicians make decisions about drug treatment this study compared eradication strategies directly. Some authors have suggested an alternate strategy of ordering strategies according to efficacy and assessing the incremental cost effectiveness of each strategy compared with the next most effective strategy after excluding dominated strategies--that is, those with lower efficacy or higher costs than another strategy.[12] This assumes that doctors or purchasers change treatments according to their willingness or ability to pay for the additional efficacy. While this is appropriate for consideration of the theoretical cost effectiveness of new drug treatments it does not sufficiently reflect the way doctors make decisions about switching from one drug treatment to another. For this reason in this economic analysis we compared each alternative strategy against the strategy with the greatest efficacy. Reanalysing our data to show the incremental cost effectiveness of each strategy compared with the next most effective strategy did not substantially alter the results.

Conclusion

Our analysis shows the value of decision analysis in situations where the results of clinical studies are not available to assess the implications of treatment choice. In particular the analysis shows the great difference in overall cost of broadly similar strategies for the eradication of H pylori in patients with duodenal ulcer disease. At a community level the effect of these differences on the overall cost of treating duodenal ulcer disease should be even greater.

Contributors: RFAL conceived the study, helped develop the model, and critically reviewed the manuscript AED helped develop the model and wrote the manuscript; she will act as guarantor for the paper. KT helped develop the model and critically reviewed the manuscript CJH critically reviewed the manuscript.

Funding: None.

Conflict of interest: None.

[1] Logan RPH. Eradication of Helicobacter pylori: which regimen, which patients? In: Farthing MJG, ed. Clinical challenges in gastroenterology. London: Martin Dunitz, 1996: 42-60.

[2] van der Hulst R, Kellar J, Rauws E, Tytgat C. Treatment of Helicobacter pylori: a review of the world literature. Helicobacter 1996;1:6-19.

[3] Sugden R, Williams A. The principles of practical cost-benefit analysis. Oxford University Press: Oxford 1978.

[4] Carrere MO, Lamouliatte H, Rufzniewski P. Is Helicobacter pylori eradication cost-effective treatment of duodenal ulcer disease? Pharmacoeconomics 1997;11:216-24.

[5] Bell GD, Powell KU, Bolton G, Richardson PDI. Clinical and pharmacological evaluation of management for duodenal ulcer disease. Br J Med Econ 1993;6:45-58.

[6] Sonnenberg A. Cost-impact of clarithromycin plus omeprazole compared to traditional therapies for treatment of H pylori associated duodenal ulcers. Gut 1996;39(suppl 3):A37.

[7] Sonnenberg A. Costs of medical and surgical treatment of duodenal ulcer. Gastroenterology 1989;96:1445-52.

[8] Pym B, Sandstad J, Seville K, Byth K, Middleton WRJ, Talley N, et al. Cost-effectiveness of cimetidine maintenance therapy in chronic gastric and duodenal ulcer. Gastroentelogy 1990;99:27-35.