The cost-effectiveness of competing strategies for the prevention of recurrent peptic ulcer hemorrhage.

摘要: Abstract OBJECTIVE: Several strategies exist for the prevention of recurrent ulcer-related hemorrhage, yet cost-effectiveness has not been evaluated and remains uncertain. The aim this study was to compare competing management considering both nonsteroidal anti-inflammatory drugs status accuracy Helicobacter pylori (H. pylori) testing. METHODS: Decision analysis used cost-per-recurrent hemorrhage prevented 11 over 1 yr. Clinical costs estimates were derived from a systematic review medical literature Medicare Fee Schedule Drug Topics Redbook. Sensitivity analyses performed important variables. RESULTS: test/retest eradication strategy with maintenance proton pump inhibitor therapy H. pylori-negative patients most effective (prevention recurrence in 96.0%). histamine-2 receptor antagonist least costly ($1070). dominant average ratios $1118–1310/recurrent antisecretory therapy. “selective” $1263–1673. model robust varying prespecified ranges. CONCLUSIONS: Test/retest are cost-effective because they maximize detection eradication, resulting fewer hemorrhages requiring