Application Of Decision Tree Model For The Pharmacoeconomics Evulation Of Three Different Kinds Of Helicobacter Pylori Eradication Regimens

Objective:To evaluate and compare the efficiency and safety of three different kinds of Helicobacter pylori eradication regimens, including bismuth quadruple therapy with clarithromycin, bismuth quadruple therapy with furazolidone and sequential therapy,respectively; Furthermore, pharmacoeconomics evaluation was conducted aim to provide the economics date for the selection of different clinical treatments.Methods:1. The 120 patients of chronic gastritis diagnosed by gastroscope, 14 C urea breath test confirmed H.pylori infection was collected, randomly divided into A, B, C three groups, each of which had 40 cases and was given 10 days of different H.pylori eradication regimens. Group A: Bismuth quadruple therapy(esomeprazole+bismuth salts+amoxicillin+clarithromycin); Group B: Bismuth quadruple therapy(esomeprazole+bismuth salt+amoxicillin+furazolidone); Group C: Sequential therapy(the first 5 days with esomeprazole+amoxicillin, the second five days with esomeprazole+clarithromycin+tinidazole). Any medicine did not be received during that period. All the patients reviewed 14C-UBT after 4 weeks when the medicine withdrawal and was followed-up during and after treatment. Then evaluate and compare the curative effect, adverse reaction and compliance of various eradication programs.2. Decision tree analyses software(TreeAge Pro 2011) was applicated to establish the tree model, which imitated the total process of H.pylori eradicationregimens. The data of drug costs and eradication rates and so on were gathered. The resume therapy and its eradication rate were determined through literature review.Finally, we determined the expected cost of each plan, conducted cost minimization analysis and calculated the cost-effectiveness ratio.Results:1. According to ITT analysis, the eradication rate of A, B, C three groups were82.5%, 87.5% and 82.5%, respectively; According to PP analysis, they were 84.6%,89.7% and 84.6%, separately. The difference among three groups was not statistically significant(P>0.05); Besides, the incidence of adverse reactions and the compliance rate of three groups had no statistical difference(P > 0.05).2. Based on the setting conditions, the expected cost of three different kinds of H.pylori eradication regimens were 645 yuan, 540 yuan, 506 yuan, separately; and the cost-effectiveness ratio were 780 yuan, 620 yuan, 780 yuan, respectively;Taking into account the pharmacoeconomics, sequential therapy was the best eradication program for H.pylori eradication.3. The sensitivity analysis results showed that: the drug costs of group B and group C usually fluctuated 20% and changed its eradication rate would influence the option of H.pylori eradication regimens, its relation to the drug retail price and eradication rate of different regions.Conclusion:1. Sequential therapy and bismuth-based quadruple therapy had similar H.pylori eradication rate; while, sequential therapy was the best regimen for H.pylori eradication, which expected cost was the lowest, when taking into account the both of clinical efficiency and pharmacoeconomics.2. The decision tree model, which simulated the process of diagnosis as well as treatment of diseases, and were simple, intuitive as well as logical, could be used forpharmacoeconomics evaluation of different H.pylori eradication regimens, aiming to provide health economics data for clinical physician.