gms | German Medical Science

Eradication therapy for peptic ulcer disease (PUD) has shown to be cost-effective in a number of studies using efficacy data from clinical trials. Our study aimed at analysing cost-effectiveness using claims data from social health insurance and hence to assess real life effectiveness and efficiency. Typical limitations of such analyses in Germany comprise lack of diagnostic accuracy and incomplete knowledge of the patients' case histories. Case finding can therefore be difficult.

From a big German sickness fund beneficiaries were analysed who had at least one case of sick leave due to PUD, no regular prescriptions of NSAIDS, and who could be observed for at least nine months in 2000 and 2001. The initial sick leave episode („index event") was used as an inclusion criterion in order to strengthen the reliability of the identification of cases suffering from manifest PUD and to enhance the selection of beneficiaries with PUD of comparable severity. Hospitalisation rates related to PUD obtained from the claims data were used as a marker for serious complications related to PUD. Costs were estimated using drug prices from the Red List and average per diems for hospitalisation obtained from the German federal agency for statistics.

Of 1,831 patients with PUD of comparable severity 212 received eradication therapy. In patients without eradication therapy 272 (17 %) hospitalisations occurred compared to 3 (1 %) hospitalisations in patients with eradication. In patients receiving eradication average cost for drug treatment was 184 EUR, cost per hospitalisation 5,974 EUR, and total cost per patient 268 EUR.

In patients without eradication cost was 86 EUR, 3,847 EUR, and 732 EUR, respectively. Compared to a scenario with a hospitalisation rate of 25 % in case of no pharmaceutical therapy at all, scheme A (no eradication) prevented from 133 hospitalisations (related to a subsample of 1,619 cases), and scheme B (eradication) from 50 hospitalisations (related to a subsample of 212 cases), respectively. Cost-effectiveness in terms of average cost to prevent from a complication was 1,045 EUR for pharmaceutical therapy without eradication and 778 EUR with eradication. Taking into account cost for pharmaceutical treatment as well as cost for hospitalisations, net savings per case treated were 230 EUR for scheme A, and 1,225 EUR for scheme B, respectively.

The use of an initial sick leave event to mark the beginning of a treatment episode is a feasible methodological approach, as both issues refer to the same diagnosis. The study shows, that cost-effectiveness analysis can be performed using claims data. Our cost model, though simplifying the course of treatment, indicates that eradication therapy is cost-effective and cost-saving under real life conditions.

Disclosure of potential conflict of interest: The study has been funded by Altana Pharma Germany.