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

Abstract

INTRODUCTION: Although beneficial, testing and treating for H. pylori in long term PPI users has not been widely adopted [1]. Possible reasons include the limited generalisability of findings and provoking reflux symptoms. Thus, the HELPUP trial (H. pylori eradication in long-term proton pump inhibitor users in primary care) was conducted [2]. After one year follow-up, eradication demonstrated significantly reduced symptom scores. Two year follow-up data are presented from the HELPUP trial quantifying the costs and consequences of detecting and eradicating H pylori in long term PPI users in primary care. AIMS & METHODS: A within-trial economic analysis of the HELPUP trial was conducted within 13 primary care practices in Hull and East Yorkshire, England. 183 H. pylori positive patients were randomly assigned to true or placebo eradication therapy and provided 2-year primary care and referral resource data. RESULTS: After two years, resource usage was reduced significantly in patients assigned to eradication therapy. PPI prescriptions (full-dose equivalents) fell by 3.9 (p<0.0001); primary care clinician consultations fell by 2.4 (p=0.0001); upper GI endoscopies fell by 14.8% (p=0.008); clinician GI-related home visits fell by 19.9% (p=0.005); and abdominal ultrasound scans fell by 20.3% (p=0.005). Average net savings per patient were �93 (95%CI: 33 to 153) when costs of detection and eradication had been deducted. At one year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (p=0.005) and quality of life measures also favoured eradication (EQ-5D: 0.089, p=0.08; VAS: 5.6, p=0.002). CONCLUSION: H. pylori detection and eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and improving symptoms after 2 years. REFERENCE(S): 1. Moayyedi P, Soo S, Deeks J, Forman D, Mason J et al. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. Dyspepsia Review Group. BMJ 2000;321:659-664.2. Raghunath AS, Hungin AP, Mason J, Jackson W. Helicobacter pylori eradication in long-term proton pump inhibitor users in primary care: a randomized controlled trial. Aliment Pharmacol Ther 2007;25:585-592.