Clinical issues and cost effectiveness of treating H pylori

Since 1987, an accumulating body of data has confirmed that patients in whom H pylori infection has been successfully eradicated have a better clinical outcome. In a managed care environment, better clinical outcome is only one of several treatment goals. Regimens to eradicate H pylori should be clinically effective, safe, and simple for both patient and provider, and promote compliance with therapy. In addition, treatment should heal or prevent symptoms and disease, avoid complications and maintain remission, and be cost effective. Several regimens are available to eradicate H pylori in patients with peptic ulcer disease. They include dual-therapy regimens, consisting of an antisecretory agent plus an antibiotic, and triple-therapy regimens, consisting of a bismuth compound and/or an antisecretory agent plus one or two antibiotics. At present, triple-therapy regimens with a proton pump inhibitor as the antisecretory agent are more efficacious, better tolerated, simpler, and associated with better compliance than are other regimens. Data regarding improved economic outcome first became available in 1995. Although these economic models indicate that patients with peptic ulcers (and perhaps those with dyspepsia as well) should be treated with antimicrobial regimens directed at eradication of H pylori, they do not address which regimen is preferable. While the regimens may differ in their pharmacy costs, the key issue is which regimen is most cost effective in terms of disease management costs. Thus, a less expensive regimen that is also less effective clinically will be associated with more disease recurrence and ultimately result in significantly higher overall costs. Conversely, a more expensive regimen that is more effective clinically is associated with less recurrence and greater cost savings in the long run. Although it has yet to be defined for all circumstances, the optimal regimen is the one with the greatest clinical efficacy, not the one that is least costly.