H pylori-Associated Ulcer Bleeding
Background: Eradication of Helicobacter pylori after peptic ulcer haemorrhage reduces the risk of recurrence. Because H. pylori treatment is very effective, it is unclear whether testing to confirm eradication is worthwhile.
Aims: To examine whether patients with H. pylori-associated peptic ulcer haemorrhage should be tested for successful eradication after completion of antibiotic therapy.
Methods: A Markov cost-effectiveness model was developed to compare testing vs. non-testing of H. pylori eradication in peptic ulcer haemorrhage. Probability estimates and average costs were derived from published information.
Results: Testing for H. pylori eradication resulted in a benefit of 0.07 quality-adjusted life-years and cost $836 less than the strategy of not confirming eradication. Testing remained the superior strategy when varying the model regarding age, the initial success of eradication, various test and retreatment strategies, and the rate and costs of recurrent bleeding. Assuming a high eradication rate (95%), the test strategy becomes more expensive only if the cost of H. pylori testing reaches $265; however, even under these conditions it remains cost-effective.
Conclusions: Patients with H. pylori-associated peptic ulcer bleeding should be tested to confirm eradiation of H. pylori after completion of antibiotic treatment.
An estimated 150 000 patients are hospitalized for a peptic ulcer haemorrhage in the United States each year and 4-10% will die from this complication. Two-thirds or approximately 100 000 patients with peptic ulcer haemorrhages are associated with Helicobacter pylori infection. Although there is a high risk of recurrent bleeding with ongoing infection, eradication of H. pylori substantially reduces this risk.
Antibiotic treatment, however, does not always successfully eradicate H. pylori. Thus, the American College of Gastroenterology has recommended that all patients be tested for H. pylori after completion of 7-14 days of therapy, and if positive, retreated. There are two reasons why providers may question this recommendation: (i) recurrent bleeding events are relatively rare and (ii) eradication is generally successful in 80-95% of patients.
Because many patients would have to be tested to benefit a few, the cost-effectiveness of this recommendation is unclear. Therefore, we developed a decision analysis model to examine whether it is cost-effective to test for H. pylori eradication after treatment of an H. pylori-associated peptic ulcer haemorrhage.
Background: Eradication of Helicobacter pylori after peptic ulcer haemorrhage reduces the risk of recurrence. Because H. pylori treatment is very effective, it is unclear whether testing to confirm eradication is worthwhile.
Aims: To examine whether patients with H. pylori-associated peptic ulcer haemorrhage should be tested for successful eradication after completion of antibiotic therapy.
Methods: A Markov cost-effectiveness model was developed to compare testing vs. non-testing of H. pylori eradication in peptic ulcer haemorrhage. Probability estimates and average costs were derived from published information.
Results: Testing for H. pylori eradication resulted in a benefit of 0.07 quality-adjusted life-years and cost $836 less than the strategy of not confirming eradication. Testing remained the superior strategy when varying the model regarding age, the initial success of eradication, various test and retreatment strategies, and the rate and costs of recurrent bleeding. Assuming a high eradication rate (95%), the test strategy becomes more expensive only if the cost of H. pylori testing reaches $265; however, even under these conditions it remains cost-effective.
Conclusions: Patients with H. pylori-associated peptic ulcer bleeding should be tested to confirm eradiation of H. pylori after completion of antibiotic treatment.
An estimated 150 000 patients are hospitalized for a peptic ulcer haemorrhage in the United States each year and 4-10% will die from this complication. Two-thirds or approximately 100 000 patients with peptic ulcer haemorrhages are associated with Helicobacter pylori infection. Although there is a high risk of recurrent bleeding with ongoing infection, eradication of H. pylori substantially reduces this risk.
Antibiotic treatment, however, does not always successfully eradicate H. pylori. Thus, the American College of Gastroenterology has recommended that all patients be tested for H. pylori after completion of 7-14 days of therapy, and if positive, retreated. There are two reasons why providers may question this recommendation: (i) recurrent bleeding events are relatively rare and (ii) eradication is generally successful in 80-95% of patients.
Because many patients would have to be tested to benefit a few, the cost-effectiveness of this recommendation is unclear. Therefore, we developed a decision analysis model to examine whether it is cost-effective to test for H. pylori eradication after treatment of an H. pylori-associated peptic ulcer haemorrhage.
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