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Cost Savings in Duodenal Ulcer Therapy Through Helicobacter pylori Eradication Compared With Conventional Therapies
Results of a Randomized, Double-blind, Multicenter Trial
Amnon Sonnenberg, MD, MSc;
J. Sanford Schwartz, MD;
Alan F. Cutler, MD;
Nimish Vakil, MD;
Bernard S. Bloom, PhD;
for the Gastrointestinal Utilization Trial Study Group
Arch Intern Med. 1998;158:852-860.
Background We hypothesized that treatment of duodenal ulcer disease with antibiotic therapy directed toward Helicobacter pylori infection is more cost-effective than therapy with antisecretory agents.
Methods A randomized, double-blind, multicenter clinical trial of adult patients with active duodenal ulcer and H pylori infection was conducted. Patients were randomized to receive 500 mg of clarithromycin 3 times a day plus 40 mg of omeprazole daily for 14 days followed by 20 mg of omeprazole daily for an additional 14 days (group 1), 20 mg of omeprazole daily for 28 days (group 2), or 150 mg of ranitidine hydrochloride twice a day for 28 days (group 3). The use of ulcer-related health care resources was documented during monthly interviews for 1 year after the initial therapy. Clinical success was evaluated 4 to 6 weeks and 1 year after the end of therapy.
Results Of the 819 patients enrolled, 727 completed the study. Group 1 included 243 patients; group 2, 248 patients; and group 3, 236 patients. Patients in group 1 used fewer ulcer-related health care resources during the 1 year after therapy compared with groups 2 and 3 (comparisons are given as group 1 vs group 2 and group 1 vs group 3, respectively): the number of endoscopies performed, 28 vs 76 (P<.001) and vs 71 (P<.001); patients receiving drugs to treat an ulcer, 118 vs 180 (P<.001) and vs 168 (P<.001); clinic visits, 83 vs 135 (P=.05) and vs 161 (P<.001); hospitalizations, 0 vs 5 (P=.045) and vs 6 (P=.02); and length of hospital stay, 0 vs 24 days (P=.04) and vs 37 (P=.04). When ulcer-related costs were defined as the outcome variable in a multivariate linear regression analysis, therapy was determined to have a significant influence on costs (group 1 vs group 2, P<.001; group 1 vs group 3, P=.008). Clinical success rates at the end of the study and cure of H pylori infection were significantly greater in group 1 compared with groups 2 and 3 (P<.001). Therapy with clarithromycin plus omeprazole provided savings of $1.94 and $2.96 (compared with therapy with omeprazole and with ranitidine hydrochloride, respectively) per dollar spent within the first year after therapy. This incremental cost-benefit translates to savings of $547 or $835 per patient in group 1 (compared with patients in group 2 or group 3, respectively) during the first year after therapy.
Conclusions Combination therapy with clarithromycin and omeprazole resulted in significantly fewer uses of ulcer-related health care resources than conventional antisecretory therapy during a 1-year follow-up and significant savings in associated costs during the same period. Patients who received clarithromycin plus omeprazole also showed a significantly improved clinical outcome compared with patients who received only omeprazole or ranitidine.
From the Department of Veterans Affairs Medical Center and the Department of Medicine, University of New Mexico, Albuquerque (Dr Sonnenberg); the University of Pennsylvania Medical School Leonard David Institute for Health Economics, Philadelphia (Drs Schwartz and Bloom); the Section of Gastroenterology, Sinai Hospital, Detroit, Mich (Dr Cutler); and the Division of Gastroenterology, University of Wisconsin Medical School, Milwaukee (Dr Vakil). Dr Vakil has received research funding and serves on the speakers bureaus for several pharmaceutical companies including Abbott Laboratories, Abbott Park, Ill. Dr Schwartz was supported through unrestricted research funding by Abbott Laboratories.
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