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Effectiveness of Helicobacter pylori Therapies in a Clinical Practice Setting
M. Brian Fennerty, MD;
David A. Lieberman, MD;
Nimish Vakil, MD;
Nathan Magaret;
Douglas O. Faigel, MD;
Mark Helfand, MD
Arch Intern Med. 1999;159:1562-1566.
Background Whether eradication rates for Helicobacter pylori treatment regimens obtained in controlled clinical trials (efficacy) can also be obtained in clinical practice (effectiveness) is unknown because no such trials have been reported in the United States.
Objectives To determine the eradication rates of H pylori in a community practice setting and the effects of practice variation in the choice of treatment regimen on patient outcome (H pylori infection cure) and cost.
Methods Between February 1 and December 30, 1996, 38 community-based gastroenterologists in the Portland, Ore, metropolitan area enrolled a total of 250 patients infected with H pylori, as determined by endoscopic or noninvasive methods. Various therapeutic regimens aimed at eradicating H pylori were used by the gastroenterologists, and a posttreatment urea breath test was used to determine H pylori infection cure. Compliance and incidental effects were also measured and decision analysis was used to estimate the cost of treatment.
Results The regimens used varied considerably. Patients receiving a 2- or 3-times-a-day treatment regimen were significantly more compliant (P=.01) than those receiving a 4-times-a-day regimen. Proton pump inhibitor–based triple-therapy regimens were significantly more effective than all other treatment regimens combined (87% vs 70%; P=.001) in eradicating H pylori. These proton pump inhibitor–based triple-therapy regimens were also more cost-effective by decision analysis for a hypothetical cohort of patients with duodenal ulcer disease.
Conclusions The considerable variation in the choice of treatment regimens affects the clinical and economic outcomes of patients undergoing therapy for H pylori infection. Whether these data reflect the outcome in other communities is unknown but should be determined. It will be necessary to determine if the dissemination of these data results in a reduction of practice variation and improvement in clinical and economic outcomes of patients being treated for H pylori infection in clinical practice.
From the Department of Medicine, Divisions of Gastroenterology, Oregon Health Sciences University (Drs Fennerty, Lieberman, and Faigel and Mr Magaret), and Division of General Internal Medicine, Veterans Affairs Medical Center (Dr Helfand), Portland; and the University of Wisconsin Medical School, Milwaukee (Dr Vakil).
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