TITLE

Eradication Therapy inHelicobacter pyloriPositive Peptic Ulcer Disease: Systematic Review and Economic Analysis

AUTHOR(S)
Ford, Alexander C.; Delaney, Brendan C.; Forman, David; Moayyedi, Paul
PUB. DATE
September 2004
SOURCE
American Journal of Gastroenterology;Sep2004, Vol. 99 Issue 9, p1833
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
BACKGROUND AND AIM: We conducted a systematic review and economic analysis to ascertain the efficacy of eradication therapy in the treatment ofH. pyloripositive peptic ulcer disease.METHODS: Comprehensive search of electronic databases, bibliographies of retrieved articles, contact with pharmaceutical companies, and experts in the field to identify published and unpublished literature from 1966 to the present. The data were incorporated into a Monte Carlo simulation Markov model that incorporated all the uncertainty in the estimates to evaluate cost-effectiveness.RESULTS: Fifty-two trials were included in the final metaanalysis. In duodenal ulcer healing,H. pylorieradication therapy was superior to ulcer healing drug (relative risk (RR) of ulcer persisting= 0.66; 95% confidence interval (CI)= 0.58 to 0.76) and no treatment (RR= 0.37; 95% CI 0.26 to 0.53). In gastric ulcer healing,H. pylorieradication therapy was not statistically superior to ulcer healing drug (RR= 1.32; 95% CI= 0.92 to 1.90). In preventing duodenal ulcer recurrence,H. pylorieradication therapy was not statistically superior to maintenance therapy with ulcer healing drug (RR of ulcer recurring= 0.73; 95% CI= 0.42 to 1.25), but was superior to no treatment (RR= 0.19; 95% CI= 0.15 to 0.26). In preventing gastric ulcer recurrence,H. pylorieradication was superior to no treatment (RR= 0.31; 95% CI 0.19 to 0.48). The Markov model suggestedH. pylorieradication is cost-effective for duodenal ulcer over 1 year and gastric ulcer over 2 years with over 95% confidence despite the uncertainty in the data.CONCLUSIONS: H. pylorieradication therapy reduces the recurrence of peptic ulcer disease and is cost-effective.(Am J Gastroenterol 2004;99:1833-1855)
ACCESSION #
14816437

 

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