Cost Effectiveness in Canada of a Multidrug Prepackaged Regimen (Hp-PAC®) for Helicobacter pylori Eradication

Objective: To assess the cost effectiveness of a multidrug prepackaged regimen for Helicobacter pylori, the Hp-PAC® (lansoprazole 30mg, clarithromycin 500mg, amoxicillin 1g, all twice daily), relative to alternative pharmacological strategies in the management of confirmed duodenal ulcer over a 1-year period from 2 perspectives: (i) a strict healthcare payer perspective (Ontario Ministry ofHealth) excluding the patient copayment; and (ii) a healthcare payer perspective including the patient copayment.Design: A decision-analytical model was developed to estimate expected per patient costs [1998 Canadian dollars ($Can)], weeks without ulcer and symptomatic ulcer recurrences for the Hp-PAC® compared with: proton pump inhibitor (PPI)-clarithromycin-amoxicillin (PPI-CA), PPI-clarithromycin-metronidazole (PPI-CM), PPI-amoxicillin-metronidazole (PPI-AM) and ranitidine-bismuth-metronidazole-tetracycline (RAN-BMT).Main outcome measures and results: All PPI-based regimens had higher expected costs but better outcomes relative to RAN-BMT. From a strict healthcare payer perspective, PPI-CM($Can209) yielded lower expected costs than PPI-CA ($Can221) and slightly lower costs than Hp-PAC® ($Can211). However, these 3 regimens all shared identical outcomes (51.2 weeks without ulcer). When the current Ontario, Canada, $Can2 patient copayment was added to the dispensing fee, Hp-PAC® yielded lower costs ($Can214) than PPI-CM ($Can216).Conclusion: From a strict healthcare payer perspective, Hp-PAC® is weakly dominated by PPI-CM with an incremental cost effectiveness (relative to RANBMT) of $Can5.77 per ulcer week averted. When the patient copayment is added to this perspective, Hp-PAC® weakly dominates PPI-CM ($Can5 per ulcer week averted). Regardless of perspective, Hp-PAC® and PPI-CM differed by only $Can2 per patient over 1 year and the expected timewithout ulcerwas 51.2 weeks for both. More data on the clinical and statistical differences in H. pylori eradication with Hp-PAC® and PPI-CM would be useful. This analysis does not include the possible advantage of Hp-PAC® in terms of compliance and antibacterial resistance.