Proximal gastric vagotomy and intermittent and maintenance
therapy with H2-antagonists have all been claimed to be effective in long-term management of
duodenal ulcer disease. The model of a Markov chain was used to compare their costs by a medical decision analysis. The high price of the initial procedure made
proximal gastric vagotomy the most expensive
therapy, its costs rising from +10,600 after 1 yr to +12,200 after 15 yr. The average costs of intermittent
therapy per patient rose from +500 to +7500. Maintenance
therapy cost as much as intermittent
therapy but provided 8% and 4% more time spent free of
ulcer relapse and
pain, respectively. In a sensitivity analysis, the order of the therapeutic options regarding their cost-effectiveness remained robust to changes in the assumptions underlying the model. In a European health care system, the initial
surgical procedure cost only one-seventh of the average annual income compared with two-thirds in the United States, and
proximal gastric vagotomy turned out to be the cheapest
therapy after 6 yr. These results suggest that maintenance
therapy provides the best long-term management. Gastric surgery may represent a cost-effective measure of
ulcer prevention in Europe but not in the United States.