Costs and benefits of a test-and-treat strategy in Helicobacter pylori-infected subjects: a prospective intervention study in general practice.

摘要

OBJECTIVE: To identify health outcomes and costs/savings of a Helicobacter pylori test-and-treat strategy in patients using acid suppressants chronically. DESIGN: Prospective intervention study. Patients were tested for H. pylori infection and treated with 14 days of ranitidine bismuth citrate (RBC) 400 mg (b.i.d.) and clarithromycin 500 mg if infected. Cure was determined after six months. SETTING: General practice. PARTICIPANTS: Patients using acid suppressants chronically were identified by a computer search; 184 patients gave written consent and were included. MAIN OUTCOME MEASURES: Serology, symptom questionnaire, medication history, quality of life determination, costs/savings. RESULTS: Out of 184 patients, 85 (46%) had positive serology. A cure rate of 61/80 (76%) was achieved. The intervention group showed significant symptom relief. Benefits were evident in patients with ulcer disease but also in patients with uninvestigated dyspepsia. Quality of life improved for cured patients in the intervention group. No improvements for dyspeptic symptoms or quality of life occurred in the H. pylori-negative group. After six months, significant savings for medication use had occurred in treated patients diagnosed as ulcer disease or non-ulcer dyspepsia. Savings on drug use and doctor visits equalize with costs for tests and antibiotics after nine months. Although less, costs for drugs also decreased significantly in the H. pylori-negative group. Therefore, for the study population, costs and savings are even after 6.5 months. CONCLUSIONS: A test-and-treat strategy for H. pylori, systematically applied at the population level in patients using acid suppressants chronically, results in significant health benefits and economic savings within 1 year of follow-up.