Abstract
Objetivo
Determinar si resulta coste-efectivo prolongar el tratamiento de 7 a 10 días en pacientes dispépticos y diferenciar entre dispepsia funcional, dispepsia no investigada y enfermedad ulcerosa.
Diseño
Estudio de coste-efectividad mediante árbol de decisión con la comparación de los costes directos por paciente curado con ambas estrategias.Horizonte temporal: 2 años; perspectiva:Sistema Nacional de Salud.
Emplazamiento
Atención primaria.
Participantes
Simulación de 100 pacientes con úlcera péptica, dispepsia funcional o dispepsia no investigada que reciben tratamiento para la infección por Helicobacter pylori.
Intervenciones
Tratamiento erradicador de H. pylori con un inhibidor de la bomba de protones, claritromicina y amoxicilina durante 7 o 10 días. Se midió el coste incremental por paciente curado.
Resultados
En pacientes con úlcera péptica,el coste incremental por paciente curado al prolongar el tratamiento erradicador de 7 a 10 días es de 147 € (intervalo de confianza [IC] del 95%, 121,3-162,7), mientras que en los pacientes con dispepsia funcional o dispepsia no investigada, es de -39,8 € (IC del 95%, -28,5 a -60,7) y -27,3 € (IC del 95%, -14,92 a -52,72), respectivamente. El análisis de sensibilidad demostró que la eficacia del tratamiento erradicador (7 frente a 10) fue la variable que más influyó en la estabilidad de los resultados.
Conclusiones
Siete días es la duración más coste-efectiva de las terapias triples para realizar tratamiento erradicador en pacientes ulcerosos. Sin embargo, las pautas de 10 días son más coste-efectivas en pacientes con dispepsia funcional o para el tratamiento de pacientes sin diagnóstico endoscópico previo.
Palabras clave: Helicobacter pylori, Costeefectividad, Tratamiento, Atención primaria, Dispepsia
Abstract
Objective
To determine through an economic evaluation study whether it is cost-effective to extend treatment of dyspeptic patients from 7 to 10 days, distinguishing between functional dyspepsia, unexamined dyspepsia, and ulcer disease.
Design
Cost-effectiveness study by means of a decision 3 comparing direct costs per patient cured with 2 strategies: a) 7 days treatment versus b) 10 days.Two-year study in the National Health System.
Setting
Primary care.
Participants
One-hundred patients with peptic ulcer, functional dyspepsia, or unexamined dyspepsia who received treatment for H pylori infection.
Interventions
H pylori eradication treatment with a proton pump inhibitor, clarithromycin,and amoxycillin for 7 or 10 days.Measurement variable: incremental cost per patient cured.
Results
In peptic ulcer patients, the incremental cost per patient cured on extending the eradication treatment from 7 to 10 days was €147 (95% CI, 121.3-162.7),whereas in patients with functional or unexamined dyspepsia, it was -€39.8 (95% CI, -28.5 to -60.7) and -€27.3 (95% CI, -14.92 to -52.72), respectively.The sensitivity analysis showed that the efficacy of eradication treatment (7 vs 10) was the factor that most affected the stability of the results.
Conclusions
Seven days is the most costeffective duration of the triple therapy for eradicating H pylori in ulcer patients.However, 10 days is more cost-effective in functional dyspepsia patients or those with no prior endoscope diagnosis.
Key words: Helicobacter pylori, Cost-effectiveness, Treatment, Primary care, Dyspepsia
Footnotes
Este artículo ha sido realizado en parte gracias a una beca concedida por el Instituto de Salud Carlos III (C03/02).
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