| Theme | Guideline for Medical Practice of Gastric Ulcers | |
|---|---|---|
| Title | Economic Evaluations in the Guidelines for Management of Gastric Ulcers in Japan | |
| Publish Date | 2004/02 | |
| Author | Yasuki Habu | Department of Gastroenterology, Saiseikai Noe Hospital |
| Author | Hideto Inokuchi | Department of Digestive Disease, Ijinkai Takeda General Hospital |
| [ Summary ] | There is growing interest in economic evaluations of medical technology. Economic considerations are important in clinical practices and the cost effectiveness issue was assessed by the guidelines preparation committee for management of gastric ulcers in Japan. A system-wide literature search was performed and economic evaluations regarding several issues of gastric ulcer treatment were identified. The papers were systematically reviewed and recommendations were produced in an evidence-based manner, i.e., graded according to the strength of evidence. A Japanese economic analysis study, comparing H.pylori eradication with conventional treatment (initially healed with PPI followed by maintenance with H2RA) clearly showed that H.pylori eradication was more effective and less costly than conventional treatment, and PPI-based triple therapy was more cost-effective than PPI-based dual therapy. Therefore, eradication with PPI-based triple therapy was strongly recommended in all H.pylori positive patients with gastric ulcers (Grade A). An Australian study showed maintenance with cimetidine was more cost effective than episodic treatment in the first two years after healing. These results were considered to be applicable in Japanese health care circumstances. Hence, maintenance therapy with H2RA was recommended in patients without indications of H.pylori eradication or patients after failure of eradication, at least until successful eradication is confirmed (Grade C). With regard to the cost effectiveness of prophylactic misoprostol in NSAID users, acute treatment of NSAID-associated gastric ulcers and the comparisons between COX-II selective inhibitors and non-selective NSAID, no firm recommendations were made due to the lack of definite data on clinical trials in Japan. |
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