Costs of duodenal ulcer therapy with antibiotics - adapted from the Archives of Internal Medicine, M

Date: Oct, 1995

Since duodenal ulcer therapy is a chronic disease that may extend over 10 to 20 years therapies include intermittent or maintenance treatment with histamine [H.sub.2] antagonists, highly selective vagotomy or use of antibiotic agents to eradicate Helicobacter pylori. Sonnenberg and Townsend compared the costs associated with these four treatment approaches and their influence on the natural course of duodenal ulcers.

Direct costs were calculated from drug costs and charges from medical services submitted to and allowed by the Health Care Financing Administration. Indirect costs were estimated from average annual income. Drug costs were estimated from their average wholesale prices, plus $5 per prescription. Ranitidine, 150 mg twice daily, was used for active therapy, and 150 mg of ranitidine at bedtime was used for maintenance therapy. Antibiotic therapy consisted of either (1) amoxicillin, 500 mg four times daily, and omeprazole, 20 mg twice daily, or (2) bismuth subsalicylate, two tablets four times daily, metronidazole, 250 mg three times daily, and tetracycline, 500 mg four times daily. The treatment period assigned for both regimens was two weeks.

The antibiotic therapy approach represented the least expensive treatment option, followed by intermittent [H.sub.2]-antagonist therapy, maintenance therapy, and then vagotomy. The costs of monthly [H.sub.2] antagonists to prevent recurrences exceeded the costs of occasional complications. The economic advantage of antibiotic therapy over all other treatment modalities became even more obvious when indirect costs were included in the analysis. Intermittent therapy with [H.sub.2] antagonists was the next least expensive treatment option. This therapy cost about three to 10 times more than antibiotic therapy, depending on whether direct or indirect costs were compared. This analysis also showed that antibiotic therapy is effective without subsequent tests to verify eradication. Compliance was determined to be the most important factor in determining the success of H. pylori eradication.

The authors conclude that patients would spend less time with active ulcers if they were treated with antibiotics, compared with other forms of therapy. Comparing all treatment strategies, high clinical efficacy and lower economic costs render antibiotics the therapy of choice for duodenal ulcers. (Archives of Internal Medicine, May 8,1995, vol.155, p.922.)

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