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Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost effective : economic analysis of the HELPUP trial.

Mason, J. M. and Raghunath, A. S. and Hungin, A. P. and Jackson, W. (2008) 'Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost effective : economic analysis of the HELPUP trial.', Alimentary pharmacology & therapeutics., 28 (11-12). pp. 1297-1303.


Background Proton pump inhibitor (PPI) use is costly and about two-thirds of prescribing is long-term. Although 20–50% of patients may be infected with Helicobacter pylori, eradication is not normal clinical practice. Aim To establish if H. pylori eradication in long-term PPI users is cost-effective. Methods Long-term PPI-using patients (n = 183) testing positive for H. pylori were randomly assigned to true or placebo eradication therapy. Patients provided 2-year resource data, and 1-year symptom severity scores. A within-trial cost effectiveness analysis was conducted from a British health service perspective. Results Significant reductions in resource use occurred comparing eradication with placebo. After 2 years, PPI prescriptions (full-dose equivalents) fell by 3.9 (P < 0.0001); clinician (GP) consultations by 2.4 (P = 0.0001); upper gastrointestinal (GI) endoscopies by 14.8% (P = 0.008); clinician GI-related home visits by 19.9% (P = 0.005) and abdominal ultrasound scans fell by 20.3% (P = 0.005). Average net savings/patient were £93 (95% CI: 33–153) after costs of detection and eradication had been deducted. At 1 year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (P = 0.005) and quality-of-life measures improved (EuroQol-5D: 0.089, P = 0.08; visual analogue scale: 5.6, P = 0.002) favouring eradication. Conclusion Helicobacter pylori eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and symptom severity.

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Record Created:27 Apr 2009 10:05
Last Modified:18 Aug 2011 10:34

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