Design: Randomised, double blind, controlled study. Patients were randomised in a 1:2 ratio to either omeprazole 40 mg once daily for eight weeks or the same treatment plus amoxycillin 750 mg twice daily for weeks 7 and 8. A 12 month untreated follow up ensued.

Setting: Teaching and district general hospitals between 1991 and 1994.

Subjects: 107 patients with benign gastric ulcer associated with H pylori.

Main outcome measures: Endoscopically confirmed relapse with gastric ulcer (analysed with life table methods), H pylori eradication, and healing of gastric ulcers (Mantel-Haenszel test).

Results: 172 patients were enrolled. Malignancy was diagnosed in 19; 24 were not infected with H pylori; four withdrew because of adverse events; and 18 failed to attend for start of treatment, leaving 107 patients eligible for analysis (35 omeprazole alone; 72 omeprazole plus amoxycillin). In the omeprazole/amoxycillin group 93% (67/72; 95% confidence interval 84% to 98%) of gastric ulcers healed and 83% (29/35; 66% to 94%) in the omeprazole group (P=0.103). Eradication of H pylori was 58% (42/72; 46% to 70%) and 6% (2/35; 1% to 19%) (P>0.001) and relapse after treatment was 22% (16/72) and 49% (17/35) (life table analysis, P>0.001), in the two groups, respectively. The recurrence rates were 7% (3/44) after successful H pylori eradication and 48% (30/63) in those who continued to be infected (P>0.001).

Conclusions: Eradication of H pylori reduces relapse with gastric ulcer over one year. Eradication rates achieved with this regimen, however, are too low for it to be recommended for routine use.

Leeds General Infirmary,
Leeds LS1 3EX
A T R Axon, professor of gastroenterology
M F Dixon, reader in gastrointestinal pathology

Meath and Adelaide Hospitals,
Dublin 8,
Republic of Ireland
C A Ó'Moráin, consultant gastroenterologist

Rotherham District General Hospital,
Rotherham S60 2UD
K D Bardhan, consultant physician

Mater Misericordiae Hospital,
Dublin 7,
Republic of Ireland
J P Crowe, consultant gastroenterologist

Southern General Hospital,
Glasgow G51 4TF
A D Beattie, consultant physician

St Thomas' Hospital,
London SE1 7EH
R P H Thompson, consultant physician

Llandough Hospital, South Glamorgan

CF64 2XX
P M Smith, consultant physician

Oldchurch Hospital,
Romford,
Essex RM7 0BE
F D Hollanders, consultant physician and gastroenterologist

St Mary's Hospital,

London W2 1NY
J H Baron, consultant physician and gastroenterologist

Leeds Public Health Laboratory,
Leeds LS15 7PR
D S Tompkins, director

Blackburn, Hyndburn and Ribble Valley Health Care NHS Trust,
Blackburn,
Lancashire BB2 3LR
D A F Lynch, consultant physician

Astra Clinical Research Unit,
Edinburgh EH7 4HG
H Birrell, clinical research scientist
K R W Gillon, head of projects

Correspondence to: Professor Axon.

Design: Economic evaluation based on the results of the Grampian region early anistreplase trial.

Setting: 29 rural general practices and one secondary care provider in Grampian, Scotland.

Subjects: 311 patients recruited to the Grampian region early anistreplase trial.

Interventions: Intravenous anistreplase given either by general practitioners or secondary care clinicians.

Main outcome measures: Survival at 4 years and costs of administration of thrombolysis.

Results: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of £425 per patient. This gives a marginal cost of life saved at 4 years of £3890 (£1990 to £42 820).

Conclusions: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.

Health Economics Research Unit,
University of Aberdeen,
Aberdeen AB9 2ZD
Luke Vale, research assistant
Jonathan Silcock, research assistant

Medicines Assessment Research Unit,
University of Aberdeen
John Rawles, honorary senior lecturer

Correspondence to: Mr Vale.