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Amnon Sonnenberg, MD; William F. Townsend, MD

Arch Intern Med. 1995;155(9):922-928.

Abstract
Background
Intermittent or maintenance therapy with histamine₂ antagonists, highly selective vagotomy, or antibiotic therapy to eradicate Helicobacter pylori all represent distinct, viable options to manage duodenal ulcer disease. Comparing the costs associated with these four approaches could help in deciding among them.

Methods
The decision model of a Markov chain was used to compare the costs of the four approaches and their influence on the natural course of duodenal ulcers. Direct costs were calculated from the average wholesale prices of drugs and from charges for medical services submitted to and allowed by the Health Care Financing Administration. Average annual income was used to estimate indirect costs.

Results
The model predicted that after antibiotic therapy, 99.7% of patient time is spent free of duodenal ulcer. The corresponding percentages were 96.6% for maintenance therapy, 94.4% for vagotomy, 89.4% for intermittent therapy, and 82.8% without therapy. For an individual patient after 15 years, the expected total costs of a treatment approach involving antibiotics are $995, compared with $10 350 for intermittent therapy with histamine₂ antagonists, $11 186 for maintenance therapy with histamine₂ antagonists, and $17 after vagotomy. Incorporating upper gastrointestinal tract endoscopy to verify eradication of H pylon raises the costs of the antibiotic therapy option to $2426. Increasing the annual infection rate of H pylori from baseline 1% to 10% raises the expected costs after 15 years to $3431. Decreasing the H pylori eradication rate from baseline 80% to 50% raises the costs to $2679.

Conclusions
Compared with other options, antibiotics to eradicate H pylori are the cheapest therapy for duodenal ulcer and provide the least time spent with an active ulcer. From an economic perspective, antibiotics represent the treatment of choice.

(Arch Intern Med. 1995;155:922-928)

Author Affiliations
From the Department of Medicine, Veterans Affairs Medical Center and Medical College of Wisconsin, Milwaukee.

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