Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy

Robert I. Griffiths, Linda Rabeneck, Gladys Guzman, David M. Cromwell, Michael J. Strauss, John W. Robinson, Bradley Winston, Theodore Li, David Y. Graham

Research output: Contribution to journalArticle

Abstract

Background. The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. Materials and Methods. A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. Results. Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. Conclusions. The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.

Original languageEnglish (US)
Pages (from-to)66-76
Number of pages11
JournalHelicobacter
Volume6
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

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Helicobacter pylori
Ulcer
Costs and Cost Analysis
Urease
Helicobacter Infections
Therapeutics
Observation
Endoscopy
Peptic Ulcer

ASJC Scopus subject areas

  • Gastroenterology
  • Microbiology

Cite this

Griffiths, R. I., Rabeneck, L., Guzman, G., Cromwell, D. M., Strauss, M. J., Robinson, J. W., ... Graham, D. Y. (2001). Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy. Helicobacter, 6(1), 66-76. https://doi.org/10.1046/j.1523-5378.2001.00008.x

Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy. / Griffiths, Robert I.; Rabeneck, Linda; Guzman, Gladys; Cromwell, David M.; Strauss, Michael J.; Robinson, John W.; Winston, Bradley; Li, Theodore; Graham, David Y.

In: Helicobacter, Vol. 6, No. 1, 2001, p. 66-76.

Research output: Contribution to journalArticle

Griffiths, RI, Rabeneck, L, Guzman, G, Cromwell, DM, Strauss, MJ, Robinson, JW, Winston, B, Li, T & Graham, DY 2001, 'Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy', Helicobacter, vol. 6, no. 1, pp. 66-76. https://doi.org/10.1046/j.1523-5378.2001.00008.x
Griffiths RI, Rabeneck L, Guzman G, Cromwell DM, Strauss MJ, Robinson JW et al. Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy. Helicobacter. 2001;6(1):66-76. https://doi.org/10.1046/j.1523-5378.2001.00008.x
Griffiths, Robert I. ; Rabeneck, Linda ; Guzman, Gladys ; Cromwell, David M. ; Strauss, Michael J. ; Robinson, John W. ; Winston, Bradley ; Li, Theodore ; Graham, David Y. / Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy. In: Helicobacter. 2001 ; Vol. 6, No. 1. pp. 66-76.
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abstract = "Background. The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. Materials and Methods. A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. Results. Among patients who were symptom free after initial therapy, 6.1{\%} receiving UBT had symptomatic ulcer at one year, compared to 18.2{\%} of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21{\%} receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8{\%} receiving repeat endoscopy, and 23.3{\%} receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. Conclusions. The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.",
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AB - Background. The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. Materials and Methods. A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. Results. Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. Conclusions. The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.

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