PMID- 11596835
OWN - NLM
STAT- MEDLINE
DCOM- 20011025
LR  - 20181113
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 19
IP  - 8
DP  - 2001
TI  - Cost effectiveness in Canada of a multidrug prepackaged regimen (Hp-PAC)+ for 
      Helicobacter pylori eradication.
PG  - 831-43
AB  - OBJECTIVE: To assess the cost effectiveness of a multidrug prepackaged regimen 
      for Helicobacter pylori, the Hp-PAC (lansoprazole 30mg, clarithromycin 500 mg, 
      amoxicillin 1 g, all twice daily), relative to alternative pharmacological 
      strategies in the management of confirmed duodenal ulcer over a 1-year period 
      from 2 perspectives: (i) a strict healthcare payer perspective (Ontario Ministry 
      of Health) excluding the patient copayment; and (ii) a healthcare payer 
      perspective including the patient copayment. DESIGN: A decision-analytical model 
      was developed to estimate expected per patient costs [1998 Canadian dollars ($ 
      Can)], weeks without ulcer and symptomatic ulcer recurrences for the Hp-PAC 
      compared with: proton pump inhibitor (PPI)-clarithromycin-amoxicillin (PPI-CA), 
      PPI-clarithromycin-metronidazole (PPI-CM), PPI-amoxicillin-metronidazole (PPI-AM) 
      and ranitidine-bismuthmetronidazole-tetracycline (RAN-BMT). MAIN OUTCOME MEASURES 
      AND RESULTS: All PPI-based regimens had higher expected costs but better outcomes 
      relative to RAN-BMT. From a strict healthcare payer perspective, PPI-CM ($Can 
      209) yielded lower expected costs than PPI-CA ($Can 221) and slightly lower costs 
      than Hp-PAC ($Can 211). However, these 3 regimens all shared identical outcomes 
      (51.2 weeks without ulcer). When the current Ontario, Canada, $Can 2 patient 
      copayment was added to the dispensing fee, Hp-PAC yielded lower costs ($Can 214) 
      than PPI-CM ($Can 216). CONCLUSION: From a strict healthcare payer perspective, 
      Hp-PAC is weakly dominated by PPI-CM with an incremental cost effectiveness 
      (relative to RAN-BMT) of $Can 5.77 per ulcer week averted. When the patient 
      copayment is added to this perspective, Hp-PAC weakly dominates PPI-CM ($Can 5 
      per ulcer week averted). Regardless of perspective, Hp-PAC and PPI-CM differed by 
      only $Can 2 per patient over 1 year and the expected time without ulcer was 51.2 
      weeks for both. More data on the clinical and statistical differences in H. 
      pylori eradication with Hp-PAC and PPI-CM would be useful. This analysis does not 
      in clude the possible advantage of Hp-PAC in terms of compliance and 
      antibacterial resistance.
FAU - Agro, K
AU  - Agro K
AD  - Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, Ontario, 
      Canada.
FAU - Blackhouse, G
AU  - Blackhouse G
FAU - Goeree, R
AU  - Goeree R
FAU - Willan, A R
AU  - Willan AR
FAU - Huang, J Q
AU  - Huang JQ
FAU - Hunt, R H
AU  - Hunt RH
FAU - O'Brien, B J
AU  - O'Brien BJ
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Anti-Ulcer Agents)
MH  - Anti-Bacterial Agents/*economics/therapeutic use
MH  - Anti-Ulcer Agents/economics/therapeutic use
MH  - Canada
MH  - *Cost-Benefit Analysis
MH  - *Decision Support Techniques
MH  - Drug Therapy, Combination
MH  - Economics, Pharmaceutical
MH  - Helicobacter Infections/*drug therapy/*economics
MH  - *Helicobacter pylori
MH  - Humans
MH  - Peptic Ulcer/drug therapy/economics
EDAT- 2001/10/13 10:00
MHDA- 2001/10/26 10:01
CRDT- 2001/10/13 10:00
PHST- 2001/10/13 10:00 [pubmed]
PHST- 2001/10/26 10:01 [medline]
PHST- 2001/10/13 10:00 [entrez]
AID - 10.2165/00019053-200119080-00005 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2001;19(8):831-43. doi: 10.2165/00019053-200119080-00005.