Outcomes research in Helicobacter pylori infection

While the medical community has accepted the role of H. pylori in the pathogenesis of peptic ulcer disease, confusion persists among clinicians regarding when and on which patients to attempt H. pylori eradication. Thus, the objective for outcomes research in H. pylori is to help clinicians identify which patients benefit from H. pylori eradication and to determine the cost-effective strategies for their diagnosis, treatment and follow-up care. Economic evaluation of the impact of H. pylori infection has focused primarily on assessment of patient with documented peptic ulcer disease, with particular attention to costs of pharmaceuticals. However, drug costs are only one portion of the total costs of management for patients with acid-related disorders and therefore must be put in the appropriate context. Additional aspects of patient benefit (e.g. patient satisfaction) and health-care expenditures (e.g. over-the-counter medications, specialist visits, hospitalizations) must be included in an evaluation of the value of a particular diagnostic test, treatment, clinical guideline or disease management strategy. As a result of the high quality and quantity of data emerging, it can be safely said that H. pylori eradication is cost-effective in selected patient populations: newly documented peptic ulcer disease; history of peptic ulcer disease and taking maintenance therapy; and suspected peptic ulcer disease using a serological test to guide initial treatment. The role of eradication in other areas, for example, patients with non-ulcer dyspepsia and screening to prevent gastric cancer, remains to be seen. In addition to the performance of rigorous studies, researchers must respond to the 'information overload' on busy clinicians, by effectively disseminating their findings. If data generated from outcomes research are not integrated into everyday clinical practice, the enormous benefits associated with H. pylori eradication will not be achieved.