2002 Volume 24 Issue 2 Pages 161-176
Peptic ulcer disease (PUD) is a common disorder that follows a chronically relapsing course. Many clinical trials have proven the efficacy of H2-blockers in the long-term management of chronic relapsing PUD. On the other hand, 30% of patients with duodenal ulcer (DU) receiving maintenance therapy with H2-blockers experience ulcer recurrence yearly. Helicobacter pylori (H. pylori) is now recognized as the major cause of PUD. We estimated the cost-effectiveness of H. pylori eradication in comparison to maintenance therapy with H2-blocker in a 1-year period at a company occupational health clinic. Ninety-nine with PUD tested for H. pylori were positive. Forty-nine patients received H. pylori eradication, and the remaining 50 patients were treated with ranitidine (RAN) 150 mg for 1 year according to their demands. H. pylori was successfully eradicated in 42 patients (86%), and 41(98%) of these 42 patients remained free of symptoms for the remainder of the study period. The lifetable probability of ulcer recurrence during 1 year was significantly lower for patients who received eradication (6.1 %) compared with those who received RAN alone (24.0%). The total cost for H. pylori eradication was lower than that for maintenance therapy along our study design (102,664 yen vs 150,356 yen). A decision tree was illustrated and the total cost were calculated by using sensitivity analysis. When we used baseline probabilities in sensitivity analysis, the total cost for eradication was lower than that for maintenance therapy (104,647 yen vs 154,468 yen). H. pylori eradication is cost-effective therapy for patients with PUD in comparison to maintenance therary with RAN at an on-site occupational health clinic in Japan.
