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Jennifer L. Taylor; Martin Zagari, MD; Karen Murphy; James W. Freston, MD, PhD

Arch Intern Med. 1997;157(1):87-97.

Abstract
Background
Patients with Helicobacter pylori— induced duodenal ulcer should have their infection eradicated. The optimal choice of antibiotic therapy, however, is less clear.

Objective
To evaluate costs and outcomes of treatment with 8 antibiotic regimens with documented activity against H pylori vs maintenance therapy with histamine₂receptor antagonists (H₂RA).

Methods
A meta-analysis for 119 studies enrolling 6416 patients to determine aggregate eradication rates. The complexity of each regimen was used to determine the anticipated compliance rate and actual effectiveness. A decision analytic model with Monte Carlo simulation determined annual costs and health outcomes.

Results
Average annual total costs of testing for H pylori infection and antibiotic treatment ranged from $223 to $410 and prevented ulcer recurrence in 70% to 86% of patients. The H₂RA maintenance therapy cost $425 and prevented recurrence in 72% of patients. The lowest costs and recurrence rates were achieved by 3 regimens: standard triple therapy (a combination of bismuth subsalicylate, metronidazole, and tetracycline hydrochloride) for 14 days ($223, with 18% recurrence); a combination of clarithromycin, metronidazole, and a proton pump inhibitor for 7 days ($235, with 15% recurrence); and standard triple therapy with a proton pump inhibitor for 7 days ($236, with 14% recurrence).

Conclusion
Treatment with any regimen resulted in lower costs compared with H₂RA maintenance therapy. Three antibiotic regimens had consistently lower costs and better outcomes: standard triple therapy for 14 days, metronidazole, clarithromycin, and a proton pump inhibitor for 7 days, and standard triple therapy plus a proton pump inhibitor for 7 days.

Arch Intern Med. 1997;157:87-97

Author Affiliations
From the Technology Assessment Group, San Francisco, Calif (Mss Taylor and Murphy and Dr Zagari), and the Department of Medicine, University of Connecticut Health Center, Farmington (Dr Freston).

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