Drug treatment to eradicate Helicobacter pylori in infected patients with non-ulcer dyspepsia may be cost-effective, according to a new meta-analysis by the dyspepsia review group (BMJ, 16 September 2000, p659).

H pylori causes peptic ulcer disease and eradication treatment cures peptic ulcers. But whether or not H pylori eradication treatment is effective in infected patients who have non-ulcer dyspepsia is a controversial area, since clinical trials have given conflicting results.

Previous reviews of the pooled data from such trials have suggested treatment may be beneficial. But cost-effectiveness was not considered, and these reviews did not include all relevant trials.

Now a new review that includes a cost-effectiveness analysis and is based on all available well-designed and executed trials has found that treatment to eradicate the bacterium leads to a 9 per cent reduction in the number of patients suffering symptoms.

The review concluded that an estimated 15 infected patients would need H pylori treatment to cure one extra case of non-ulcer dyspepsia and that H pylori eradication cost£56 per dyspepsia-free month during the first year after treatment.

Study author and senior lecturer in health economics from York University's centre for health economics James Mason said:

'Despite the small clinical effect, H pylori eradication treatment might be a cost-effective intervention for non-ulcer dyspepsia provided the cost per month free from dyspepsia is acceptable to decision-makers.'

The review was based on the pooled data from nine trials, only three of which had reported a significant benefit of eradication treatment. But none of the nine trials had sufficient power to detect treatment benefits as small as that observed in the review.