Eradicating Helicobacter pylori in peptic ulcer disease reduces medical costs in the community.

ABSTRACT

BACKGROUND: Eradicating Helicobacter pylori markedly reduces ulcer recurrence in patients with peptic ulcer disease (PUD). Many decision analysis studies have concluded that eradicating H. pylori in PUD patients is more cost-effective than maintaining antisecretory therapy. In 1995, we introduced an H. pylori eradication program into a large transportation company that experienced increased incidences of PUD among its employees along with increased medical costs, and we performed trend analysis of the actual medical costs of PUD in this cohort. METHODS: In this cohort, there were approximately 8500 employees. H. pylori-positive PUD patients were identified at the annual health check up. The patients received eradication therapy with lansoprazole, amoxicillin, and clarithromycin. After eradication, the patients were followed up by a yearly health check up. The annual number of patients who received eradication was recorded, and the annual direct medical costs of PUD therapy were analyzed. RESULTS: A total of 440 H. pylori-positive PUD patients received eradication therapy in a 7-year period. Based on an intention-to-treat analysis, the eradication rate was 84.5% (372 of 440). The largest number of patients who received eradication therapy was found in 1995 (n = 115), and from 1995 to 2001 this number decreased yearly by 12.5 (95% confidence interval (CI) 5 to 20). Between 1989 and 1995, the annual medical costs arising of PUD therapy increased by yen2.25 million (95% CI 1.19 to 3.31) per year, being highest ( yen22.75 million) in 1995. Between 1995 and 2001, the costs decreased by yen3.88 million (95% CI 3.16 to 4.59) per year. The cost in 2001 was 5.7% of the cost in 1995. The eradication program was terminated in 2001 because the prevalence of PUD diminished markedly, and the associated medical costs decreased as well. CONCLUSIONS: H. pylori eradication could reduce the number of PUD patients and associated medical costs in the workplace setting.