Analytical approach:
This economic evaluation was based on a single study with a two-year time horizon. The authors stated that the perspective of the National Health Service was adopted.
Effectiveness data:
The clinical evidence came from the H. pylori Eradication in Long-term Proton pump inhibitor Users in Primary care (HELPUP) trial. This was a double-blind, parallel group, randomised trial, which enrolled 184 eligible patients in 13 primary care practices in the North East of England. The length of follow-up for clinical outcomes was one year. Further details of the trial were not reported. The primary clinical estimate was the improvement in dyspepsia symptoms, measured by the Leeds Dyspepsia Questionnaire.
Monetary benefit and utility valuations:
The data on quality of life were measured at baseline and after 12 months, using the European Quality of life questionnaire (EQ-5D), for all patients enrolled in the HELPUP trial.
Measure of benefit:
The summary benefit measures were the improvement in dyspepsia symptoms measured by the Leeds Dyspepsia Questionnaire (LDQ), improvement in reflux symptoms measured by the Carlsson and Dent reflux questionnaire, and quality of life. The two clinical endpoints were assessed over a one-year time horizon.
Cost data:
The economic analysis included the costs of PPIs, eradication therapy, carbon 13-urea breath test, visits to the general practitioner (GP), GP home visits, accident and emergency department visits, hospital admissions, ultrasound of the abdomen, endoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, computed tomography, and magnetic resonance imaging. The resource use was estimated from the clinical trial using two-year follow-up data. The unit costs were reported and were derived from official UK price lists such as the British National Formulary, the National Schedule Reference Costs, and the Personal Social Services Research Unit. All costs were in UK pounds sterling (£) and the price year was 2006.
Analysis of uncertainty:
A deterministic sensitivity analysis was undertaken to determine the impact of variations in the unit costs, prevalence of disease, and eradication rates on the magnitude of the cost savings. The alternative values used in the analysis appear to have been selected by the authors. In addition, bootstrapping was performed to generate 95% confidence intervals (CIs) around the costs and benefits.