| 特集名 | 胃潰瘍診療ガイドラインをめぐって | |
|---|---|---|
| 題名 | 医療経済的評価からみた胃潰瘍診療ガイドライン | |
| 発刊年月 | 2004年 02月 | |
| 著者 | 羽生 泰樹 | 大阪府済生会野江病院消化器科 |
| 著者 | 井口 秀人 | 医仁会武田総合病院消化器科 |
| 【 要旨 】 | 胃潰瘍診療ガイドラインの医療経済的評価について，以下のステートメントが作成された． (1) 除菌治療は従来治療より，また3剤併用療法は2剤併用より費用効果に優れる．したがってHelicobacter pylori陽性潰瘍では3剤併用療法による除菌治療が強く勧められる (グレードA，レベルI)． (2) H2RA維持療法は治癒後2年間までは間欠療法より費用効果に優れる (オーストラリア)．わが国では，除菌適応外または除菌不成功例において一定期間，H2RA維持療法が勧められる (グレードC，レベルV)． (3) ミソプロストール予防投与，(4) NSAID潰瘍の初期治療，(5) 非選択的NSAIDとCOX-2選択的阻害薬の比較に関して，現時点で積極的な勧告は行えない (グレードC，レベルV)． |
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| Theme | Guideline for Medical Practice of Gastric Ulcers | |
|---|---|---|
| Title | Economic Evaluations in the Guidelines for Management of Gastric Ulcers in Japan | |
| 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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