Economic evaluation of Helicobacter pylori eradication in the management of duodenal ulcer

The association between gastric H. pylori infection and peptic ulcer disease (PUD) is well established1, and many studies have shown that eradication of H. pylori infection with various antimicrobial agents reduces ulcer recurrence2,3. This has important implications for the long-term clinical management of PUD where traditional emphasis has been on acid-suppressing drug therapy such as H2-receptor antagonists (e.g. ranitidine) and, more recently, proton pump inhibitors (PPI) such as omperazole. A recent consensus conference of the US National Institutes of Health noted that ‘nearly all patients with duodenal ulcer have H. pylori’ and that the association with gastric ulcer is ‘only slightly less strong’. The NIH consensus panel recommended treatment with antimicrobial agents for PUD patients with H. pylori in addition to antisecretory drugs, whether on first presentation with the illness or on recurrence4. Despite concerns about the cost implications of acid-suppressing drug therapy in a chronic recurrent disease such as PUD5, the economic implications of H. pylori eradication compared to an alternative drug therapy such as omeprazole have received little research attention.