Official journal of the American College of Gastroenterology | ACG
CLINICAL REVIEW
Systematic Review and Economic Analysis
Ford, Alexander C. M.B.Ch.B., M.R.C.P; Delaney, Brendan C. M.B.Ch.B., M.D., F.R.C.P; Forman, David B.A., Ph.D., F.F.P.H.M; Moayyedi, Paul M.B.Ch.B., B.Sc., Ph.D., F.R.C.P
Centre for Digestive Diseases, Leeds General Infirmary, Great George Street, Leeds, UK
University of Birmingham, Birmingham, UK
Cochrane Upper Gastrointestinal and Pancreatic Diseases Review Group, Leeds, UK
Reprint requests and correspondence: Paul Moayyedi, City Hospital, Dudley Road, Winson Green, Birmingham, B18 7QH, United Kingdom.
Received January 6, 2004; accepted March 27, 2004.
Abstract
BACKGROUND AND AIM:
We conducted a systematic review and economic analysis to ascertain the efficacy of eradication therapy in the treatment of H. pylori positive peptic ulcer disease.
METHODS:
Comprehensive search of electronic databases, bibliographies of retrieved articles, contact with pharmaceutical companies, and experts in the field to identify published and unpublished literature from 1966 to the present. The data were incorporated into a Monte Carlo simulation Markov model that incorporated all the uncertainty in the estimates to evaluate cost-effectiveness.
RESULTS:
Fifty-two trials were included in the final metaanalysis. In duodenal ulcer healing, H. pylori eradication therapy was superior to ulcer healing drug (relative risk (RR) of ulcer persisting = 0.66; 95% confidence interval (CI) = 0.58 to 0.76) and no treatment (RR = 0.37; 95% CI 0.26 to 0.53). In gastric ulcer healing, H. pylori eradication therapy was not statistically superior to ulcer healing drug (RR = 1.32; 95% CI = 0.92 to 1.90). In preventing duodenal ulcer recurrence, H. pylori eradication therapy was not statistically superior to maintenance therapy with ulcer healing drug (RR of ulcer recurring = 0.73; 95% CI = 0.42 to 1.25), but was superior to no treatment (RR = 0.19; 95% CI = 0.15 to 0.26). In preventing gastric ulcer recurrence, H. pylori eradication was superior to no treatment (RR = 0.31; 95% CI 0.19 to 0.48). The Markov model suggested H. pylori eradication is cost-effective for duodenal ulcer over 1 year and gastric ulcer over 2 years with over 95% confidence despite the uncertainty in the data.
CONCLUSIONS:
H. pylori eradication therapy reduces the recurrence of peptic ulcer disease and is cost-effective.
(Am J Gastroenterol 2004;99:1833-1855)