Cost-effectiveness Analysis On The Xinjiang Area Uygur Standard Triple And Quadruple Therapy In The Eradication Of Helicobacter Pylori Infection

Object:To make a comparative analysis of the cost-effectiveness of the eradication of Helicobacter pylori(H. pylori) infection in Uygur patients with chronic gastritis and peptic ulcer by standard triple therapy and quadruple therapy containing bismuth.Methods:From Dcember 2014 to October 2015, 400 Uygur patients who were definitely diagnosed with gastritis and peptic ulcer by gastroscopy, showed positive for 13C-UBT, and were diagnosed with Hp infection were enrolled from the People’s Hospital of Xinjiang Uygur Autonomous Region. Using random number table, the subjects were divided into four groups: group A(pantoprazole + clarithromycin + metronidazole), group B(pantoprazole + clarithromycin + amoxicillin), group C(bismuth pectin + pantoprazole + clarithromycin + metronidazole) and group D(bismuth pectin + pantoprazole + clarithromycin +amoxicillin). After treatment for 14 days, the cost-effectiveness analysis was conducted. The adverse effects were observed and recorded during treatment. The rate of Hp eradication was analyzed by the intention- to-treat(ITT) analysis and per protocol(PP) analysis. Results:1.In group A, group B, group C and group D, there were respectively 98, 99, 97 and 97 patients who completed the whole treatment. The four groups were not significantly different in the remission rate on day 1, day 3, day 7 and day 14(P>0.05).2. According to ITT analysis, the eradication rate of A, B, C, D group was 80.0%(80/100), 86.0%(86/100), 90.0%(90/100) and 93.0%(93/100) respectively, with significant differences among the four groups(χ2=8.52,P<0.05), and the rate was 81.6%(80/98), 86.9%(86/99), 92.8%(90/97) and 95.9%(93/97) respectively according to PP analysis, with significant differences among the four groups(χ2=12.22,P<0.05). Group D was higher than group A in Hp eradication rate(P<0.01).3. In the four groups, there were respectively 2(2%), 3(3%), 4(4%) and 4(4%) patients who had adverse reactions, and the four groups were not significant different in the incidence of adverse reactions(χ2=1.025,P>0.05).4. The cost- effectiveness ratios of the four groups was 7.57, 7.23, 7.01 and 6.90. The therapy with the lowest cost was taken as the reference in incremental cost-effectiveness ratio[?C/?E=(C1-C2)/(E1-E2)], and ?C/?E of other therapies was calculated. Group A which had lowest cost was taken as the reference, and the ?C/?E of group B, C and D was 1.90, 3.04 and 3.08 respectively. Conclusion:From the perspective of ?C/?E, the therapy of proton pump inhibitor, clarithromycin and amoxicillin is more economic and rational for the eradication of Hp.