0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

A Cost Analysis of Alternative Treatments for Duodenal Ulcer

Thomas F. Imperiale, MD; Theodore Speroff, PhD; Randall D. Cebul, MD; and Arthur J. McCullough, MD
[+] Article and Author 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.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;123(9):665-672. doi:10.7326/0003-4819-123-9-199511010-00004
Text Size: A A A

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.

Figures

Grahic Jump Location
Figure 1.
Decision tree for the treatment of duodenal ulcer.2RA2Helicobacter pylori2Helicobacter pylori

The decision tree identifies decision alternatives and their clinical outcomes. H equals treatment with an H -receptor antagonist alone; HpRx equals treatment with antibiotics for infection plus an H -receptor antagonist; HP equals .

Grahic Jump Location
Grahic Jump Location
Figure 2.
Two-way sensitivity analysis showing the average direct cost per ulcer cure as a function of the prevalence of Helicobacter pylori for each initial strategy.2RA2Helicobacter pylori2

Repeat endoscopy is the secondary strategy for ulcer recurrence. The two broken vertical lines delineate three areas in which the least costly initial strategy is shown. H equals treatment with an H -receptor antagonist alone; HpRx equals treatment with antibiotics for infection plus an H -receptor antagonist; urease equals urease test-based treatment.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Three-way sensitivity analysis comparing initial treatment with an H2-receptor antagonist alone and initial treatment with antibiotics for Helicobacter pylori infection plus an H2-receptor antagonist.H. pyloriH. pylori22H. pylori2

This analysis shows the threshold for long-term cure when the prevalence of infection is 70% to 100%. Secondary treatment is antibiotics for infection plus an H -receptor antagonist. Base-case point is the open circle at the intersection of the two broken lines. H2RA equals H -receptor antagonist; HpRx equals antibiotics for infection plus an H -receptor antagonist.

Grahic Jump Location
Grahic Jump Location
Figure 4.
Three-way sensitivity analysis comparing urease test-based treatment and treatment with antibiotics for Helicobacter pylori infection plus an H2-receptor antagonist as initial treatment.2H. pylori2H. pyloriH. pylori22H. pylori2

This analysis shows the thresholds for costs of treatment with an H -receptor antagonist alone and treatment with antibiotics for infection plus an H -receptor antagonist when the prevalence of is 70% to 100%. Secondary treatment is antibiotic treatment for infection plus an H -receptor antagonist. Base-case point is the open circle at the intersection of the two broken lines. H2RA equals H -receptor antagonist; HpRx equals antibiotics for infection plus an H -receptor antagonist.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)