The cost-effectiveness of competing strategies for the prevention of recurrent peptic ulcer hemorrhage
| Autor: | Chiun-Fang Chiou, Joshua J. Ofman, Enkhe Badamgarav, Joel Wallace, James M. Henning, Loren Laine |
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| Rok vydání: | 2002 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness Cost-Benefit Analysis MEDLINE Peptic Ulcer Hemorrhage Helicobacter Infections Recurrence Internal medicine Humans Medicine Helicobacter pylori Hepatology biology business.industry Vascular disease Gastroenterology Anti-Ulcer Agents biology.organism_classification medicine.disease Surgery Histamine H2 Antagonists Etiology business Medical literature Decision analysis |
| Zdroj: | The American Journal of Gastroenterology. 97:1941-1950 |
| ISSN: | 1572-0241 0002-9270 |
| DOI: | 10.1111/j.1572-0241.2002.05904.x |
| Popis: | OBJECTIVE: Several strategies exist for the prevention of recurrent ulcer-related hemorrhage, yet the cost-effectiveness has not been evaluated and remains uncertain. The aim of this study was to compare the cost-effectiveness of competing management strategies considering both nonsteroidal anti-inflammatory drugs status and the accuracy of Helicobacter pylori (H. pylori) testing. METHODS: Decision analysis was used to compare the cost-per-recurrent hemorrhage prevented for 11 strategies over 1 yr. Clinical and costs estimates were derived from a systematic review of the medical literature and the Medicare Fee Schedule and Drug Topics Redbook. Sensitivity analyses were performed for important variables. RESULTS: The test/retest eradication strategy with maintenance proton pump inhibitor therapy for H. pylori-negative patients was most effective (prevention of recurrence in 96.0%). The test/retest eradication strategy with maintenance histamine-2 receptor antagonist therapy for H. pylori-negative patients was least costly ($1070). The test/retest strategies were dominant with average cost-effectiveness ratios of $1118–1310/recurrent hemorrhage prevented with maintenance antisecretory therapy. The average cost-effectiveness ratios for “selective” H. pylori eradication strategies with maintenance antisecretory therapy were $1263–1673. The model was robust to varying estimates over prespecified ranges. CONCLUSIONS: Test/retest strategies for H. pylori are cost-effective for the prevention of recurrent ulcer-related hemorrhage because they maximize H. pylori detection and eradication, resulting in fewer recurrent hemorrhages and fewer patients requiring antisecretory therapy. |
| Databáze: | OpenAIRE |
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