"Best practice' for Helicobacter pylori eradication in the primary care setting

Area of Science:

• Gastroenterology
• Pharmacoeconomics
• Infectious Disease Management

Background:

• Helicobacter pylori (H. pylori) infection is a common cause of gastrointestinal diseases.
• Proton pump inhibitor (PPI) based triple therapy is a standard treatment for H. pylori eradication.
• Evaluating the cost-effectiveness of different PPI regimens is crucial for optimizing primary care treatment strategies.

Purpose of the Study:

• To determine the relative cost-effectiveness of various PPI-based triple therapy regimens for H. pylori eradication.
• To identify the most economically viable treatment strategy in a primary care setting.

Main Methods:

• Decision tree analysis was employed to model the expected costs of different H. pylori eradication strategies.
• Probabilities for treatment outcomes were derived from the GMS prescribing database (ERHA region, 2002).
• Patient data from those receiving amoxycillin, clarithromycin, and a PPI were followed for one year.

Main Results:

• Between 40.8% and 46.1% of patients did not require further medication post-H. pylori eradication treatment, depending on the regimen.
• The combination of rabeprazole, amoxycillin, and clarithromycin emerged as the most cost-effective strategy.
• The cost for this optimal strategy was calculated at Euro466 per asymptomatic patient.

Conclusions:

• Rabeprazole, amoxycillin, and clarithromycin triple therapy represents the most cost-effective approach for H. pylori eradication in Irish primary care.
• Sensitivity analysis confirmed that significant cost increases (30%) for rabeprazole therapy or maintenance would be required to challenge its cost-effectiveness.
• This regimen is recommended as the best practice option for H. pylori treatment in this setting.