Authors' objectives:

A study commissioned by CCOHTA entitled 'Cost-effectiveness of alternative therapies for the long-term management of peptic ulcer disease' evaluates different drug treatment strategies available for the management of patients with PUD. Specifically, the study compares maintenance ranitidine to treatment of acute ulcer with omeprazole or ranitidine, as well as H.pylori eradication regimens. This overview attempts to put the findings of the commissioned study into clinical perspective.

Authors' recommendations: 1. All H2 antagonists have similar ulcer healing rates. 2. There are too few studies available to evaluate differences between omeprazole and the new proton pump inhibitor (PPI) lansoprazole. 3. Of the two acute ulcer healing regimens (intermittent omeprazole and intermittent ranitidine), intermittent omeprazole is the most effective and the least costly option. 4. The H.pylori eradication regimens are more effective (increased rate of healing and decreased recurrences) than either treating only the acute ulcer episodes or providing maintenance ranitidine. In terms of direct health care costs, four of the six regimens cost less per patient per year and have better outcomes than maintenance ranitidine. 5. Of the H.pylori eradication regimens, ranitidine-bismuth triple therapy is the least expensive but also the least effective. Omeprazole in combination with two antibiotics decreases the time with ulcer by 12 to 13 days compared to the ranitidine-bismuth triple therapy but at an extra cost ranging from 64 to 108 USD per patient per year. 6. Study limitations include the use of efficacy data and expert opinions instead of effectiveness studies. Also, a Ministry of Health perspective is taken instead of a societal one. 7. The results of the commissioned study are comparable to those conducted in other countries with H.pylori eradication regimens being the most effective therapy for PUD.

Authors' methods: Overview

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 1996

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment