Original Title: Abordaje diagnóstico y terapéutico de la úlcera duodenal no complicada

Authors' objectives: This survey aims to assess the effectiveness and costs of different diagnostic and therapeutic approaches to non complicated duodenal ulcer in the Autonomous Community of the Basque Country.

Authors' recommendations: Eradicating treatments which include two or more antibiotics are clinically the most effective treatments in patients infected with Helicobacter pylori, and these prevent a high number of recurring ulcers that would be produced with treatment with antisecretory drugs alone. The best choice is to treat all duodenal ulcers with bismuth, metronidazol and tetracicline for seven days, without making any diagnostic tests for infection. This option allows the prevention of most recurring ulcers and at the same time leads to the lowest average health care costs per patient treated. The strategy of providing this eradicating treatment to all patients without making any diagnostic test of the infection is considered to be reasonable as a high infection rate of over 90% has been found in ulcerous patients, and the sensitivity of the diagnostic tests available is low. The second most preferable option would be to make a series of up to three infection diagnoses as this provides clinical results ony slightly lower than the previous one, and better economic results than all the other options apart from the one considered to be the best. In the case of a negative result in the first diagnostic infection test, it is recommended to perform another, different test, and even a third one should the second one provde to be negative. In patients that give negative results in the three tests, it is recommended to treat with omeprazol for 29 days.

Authors' methods: Data was gathered on the prevalence of Helicobacter pylori infections in patients with duodenal ulcer in the Autonomous Community of the Basque Country, on the sensitivity and specificity of the different tests and diagnosis of infection. A bibliographical search was made of Clinical Tests that analyse the different treatments and the prevention of recurring ulcers. Data was gathered on the costs of different diagnostic and therapeutic strategies. Using the aforementioned data, an analysis was made, on the one hand, of the clinical decisions taken in the different strategies, and an appraisal was made of their results in the prevention of recurring ulcers. On the other hand, a cost-efficiency analysis was made of costs per prevented ulcer for the different options.

Project Status: Completed

Year Published: 2000

URL for published report: https://www.euskadi.eus/contenidos/informacion/2000_osteba_publicacion/es_def/adjuntos/2000/d_00_01_ulcera_duodenal.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment, Health Department Basque Government (OSTEBA)</p>