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. 2006 Dec;38(10):555-62.
doi: 10.1157/13095927.

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

[Article in Spanish]
Emili Gené  1 , Xavier Calvet, Rafael Azagra, Javier P Gisbert
Affiliations

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

[Article in Spanish]
Emili Gené et al. Aten Primaria. 2006 Dec.

Abstract
in English, Spanish

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 euro147 (95% CI, 121.3-162.7), whereas in patients with functional or unexamined dyspepsia, it was -euro39.8 (95% CI, -28.5 to -60.7) and -euro27.3 (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.

Objetivo: Determinar si resulta coste-efectivo prolongar el tratamiento de 7 a 10 días en pacientes dispépticos y diferenciar entre dispepsia funcional, dispepsia no investigada y enfermedad ulcerosa.

Diseño: Estudio de coste-efectividad mediante árbol de decisión con la comparación de los costes directos por paciente curado con ambas estrategias.Horizonte temporal: 2 años; perspectiva:Sistema Nacional de Salud.

Emplazamiento: Atención primaria.

Participantes: Simulación de 100 pacientes con úlcera péptica, dispepsia funcional o dispepsia no investigada que reciben tratamiento para la infección por Helicobacter pylori.

Intervenciones: Tratamiento erradicador de H. pylori con un inhibidor de la bomba de protones, claritromicina y amoxicilina durante 7 o 10 días. Se midió el coste incremental por paciente curado.

Resultados: En pacientes con úlcera péptica,el coste incremental por paciente curado al prolongar el tratamiento erradicador de 7 a 10 días es de 147 € (intervalo de confianza [IC] del 95%, 121,3-162,7), mientras que en los pacientes con dispepsia funcional o dispepsia no investigada, es de -39,8 € (IC del 95%, -28,5 a -60,7) y -27,3 € (IC del 95%, -14,92 a -52,72), respectivamente. El análisis de sensibilidad demostró que la eficacia del tratamiento erradicador (7 frente a 10) fue la variable que más influyó en la estabilidad de los resultados.

Conclusiones: Siete días es la duración más coste-efectiva de las terapias triples para realizar tratamiento erradicador en pacientes ulcerosos. Sin embargo, las pautas de 10 días son más coste-efectivas en pacientes con dispepsia funcional o para el tratamiento de pacientes sin diagnóstico endoscópico previo.

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