BMJ 2000;321:659-664 ( 16 September )

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Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia

Editorial by van Zanten

Paul Moayyedi, senior lecturer, ^a Shelly Soo, research fellow, ^a Jonathan Deeks, head, ^b David Forman, professor of cancer epidemiology, ^c James Mason, senior lecturer in health economics, ^d Michael Innes, research fellow, ^e Brendan Delaney, senior lecturer, ^e on behalf of the Dyspepsia Review Group.

^a Gastroenterology Unit, Centre for Digestive Diseases, General Infirmary at Leeds, Leeds LS1 3EX, ^b Systematic Review Development Programme, ICRF/NHS Centre for Statistics in Medicine, Institute of Health Sciences, Oxford OX3 7LF, ^c Cochrane Upper Gastrointestinal and Pancreatic Diseases Group, University of Leeds, Leeds LS2 9LN, ^d Centre for Health Economics, University of York, York YO1 5DD, ^e Department of General Practice, University of Birmingham, Medical School, Birmingham B15 2TT

Correspondence to: B Delaney B.C.Delaney{at}bham.ac.uk

Objectives: To evaluate efficacy and cost effectiveness of Helicobacter pylori eradication treatment in patients with non-ulcer dyspepsia infected with H pylori.
Design: Systematic review of randomised controlled trials comparing H pylori eradication with placebo or another drug treatment. Results were incorporated into a Markov model comparing health service costs and benefits of H pylori eradication with antacid treatment over one year.
Data sources: Six electronic databases were searched for randomised controlled trials from January 1966 to May 2000. Experts in the field, pharmaceutical companies, and journals were contacted for information on any unpublished trials. Trial reports were reviewed according to predefined eligibility and quality criteria.
Main outcome measures: Relative risk reduction for remaining dyspeptic symptoms (the same or worse) at 3-12 months. Cost per dyspepsia-free month estimated from Markov model based on estimated relative risk reduction.
Results: Twelve trials were included in the systematic review, nine of which evaluated dyspepsia at 3-12 months in 2541 patients. H pylori eradication treatment was significantly superior to placebo in treating non-ulcer dyspepsia (relative risk reduction 9% (95% confidence interval 4% to 14%)), one case of dyspepsia being cured for every 15 people treated. H pylori eradication cost £56 per dyspepsia-free month during first year after treatment.
Conclusion: H pylori eradication may be cost effective treatment for non-ulcer dyspepsia in infected patients but further evidence is needed on decision makers' willingness to pay for relief of dyspepsia.

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Rapid Responses:

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Why no remission in the Markov model?

Graham Byrnes
bmj.com, 18 Sep 2000 [Full text]

Rapid response-Helicobacter eradication in non-ulcer dyspepsia

A Poullis
bmj.com, 19 Sep 2000 [Full text]

Re: Why no remission in the Markov model?

Brendan Delaney
bmj.com, 27 Sep 2000 [Full text]