A Cost Analysis of Alternative Treatments for Duodenal Ulcer

1 November 1995 | Volume 123 Issue 9 | Pages 665-672

Objective: To compare the costs of alternative strategies for the treatment of duodenal ulcer.

Design: A cost comparison using decision analysis.

Methods: A decision model was used to compare the costs per cure of an endoscopically documented duodenal ulcer for three initial treatment strategies: 1) H₂-receptor antagonist therapy for 8 weeks, 2) antibiotic therapy for Helicobacter pylori infection plus H₂-receptor antagonist therapy, and 3) urease test-based treatment. For symptomatic recurrences, secondary treatment strategies included empiric retreatment with the same or other regimen, and treatment based on repeat endoscopy-guided urease test or biopsy, with an assumption of subsequent cure. The cohort modeled for this analysis consisted of patients at low risk for a malignant ulcer. Probability estimates were derived from published clinical trials, cohort studies, and expert opinion. Side effects from combination therapy with antibiotics and H₂-receptor antagonists and resulting costs were included from the perspective of a group practice model health maintenance organization.

Results: For all secondary treatment strategies, initial therapy with antibiotics for H. pylori infection plus an H₂-receptor antagonist resulted in the lowest average costs per symptomatic cure when the prevalence or likelihood of H. pylori infection exceeded 66% to 76%; the costs ranged from $284 for secondary (re)treatment with empiric antibiotic and H₂-receptor antagonist therapy to $398 for endoscopy-guided secondary treatment. Initial treatment with an H₂-receptor antagonist resulted in the highest costs, ranging from $372 for secondary treatment with empiric antibiotic and H₂-receptor antagonist therapy to $679 for endoscopy-guided secondary treatment. The results were not sensitive to the rates of duodenal ulcer recurrence after either treatment, to the cost of either treatment, or to prevalence of H. pylori.

Conclusions: This cost analysis indicates that, regardless of the secondary treatment used for ulcer recurrence, initial therapy with antibiotics for H. pylori infection plus an H₂-receptor antagonist provides the lowest costs per symptomatic cure. These cost savings and the lower recurrence rates associated with this treatment favor eradication of H. pylori as part of the initial treatment of duodenal ulcer.

Author and Article Information

From Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio.
Acknowledgments: The authors thank Barbara West and Shirley Lawson for gathering cost information, Vickie Stepka for assistance with the figures, and Linda Gall and Janet Phillips for preparation of the manuscript.
Current Author Addresses: Drs. Imperiale, Cebul, and McCullough: MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. Dr. Speroff: Magic Valley Regional Medical Center, 650 Addison Avenue West, Twin Falls, ID 83301.