Management strategies for duodenal ulcer in India in the helicobacter pylori era: an economic analysis.

ABSTRACT

BACKGROUND: Duodenal ulcer (DU) is widely prevalent in India. Eradication of Helicobacter pylori (H. pylori) is considered to be the most cost-effective first-line therapy for DU in patients without a historyof use of non-steroidal anti-inflammatory drugs. Western investigators recommend initial empirical anti-H. pylori therapy for such patients. However, in India similar recommendations are lacking due to the absence of appropriate clinical studies. METHODS: An economic analysis for the management of DU with particular attention to H. pylori infection was performed using a decision analysis model. Three treatment strategies for DU diagnosed at index endoscopy were evaluated in strategy I, anti-secretory therapy alone was administered for 8 weeks; in strategy II, a urease test and histological examination for H. pylori was performed at the time of initial endoscopy and subsequent management was based on the result of these tests; and in strategy III, empirical triple therapy for possible H. pylori infection was considered. Costs per patient treated were the outcome variables compared among the three strategies. RESULTS: In the baseline analysis, the cost per patient managed with initial anti-secretory therapy alone was Rs 544, cost of performing the urease test and histological examination at the time of initial endoscopy and subsequent treatment was Rs 692, and strategy III of empirical triple therapy for H. pylori yielded a cost per patient of Rs 523. Sensitivity analysis with a wide range of clinical probabilities and cost estimates and a second-order Monte Carlo simulation supported the conclusions of the baseline analysis. CONCLUSION: Initial empirical triple therapy followed by anti-secretory therapy is the most cost-minimizing approach for the treatment of endoscopically documented DU in India.