Analysis of the cost-effectiveness of using vonoprazan-amoxicillin-clarithromycin triple therapy for first-line Helicobacter pylori eradication.
BACKGROUND
Vonoprazan (VPZ)-based triple therapy has been reported to have greater efficacy than a proton pump inhibitor (PPI)-based triple therapy for Helicobacter pylori (H. pylori) eradication. However, because VPZ is more expensive than PPIs such as rabeprazole (RPZ), economic evaluation is essential.


METHODS
We performed a retrospective study on 209 patients who underwent first-line eradication of H. pylori infection in Fuyoukai Murakami Hospital from 1 March 2015 to 31 March 2016. Patients who received VPZ, amoxicillin (AMPC) and clarithromycin (CAM) were assigned to the VPZ/AC group (n = 111) and patients who received RPZ, AMPC and CAM to the RPZ/AC group (n = 98). We compared the patients' backgrounds, including age, gender, use of high-dose CAM, past history of peptic ulcer, smoking and drug-related adverse events between the two groups. We defined cost as direct medical costs per patient and effectiveness as the first-line eradication rate in the intention-to-treat (ITT) analysis and analyzed the cost-effectiveness using the cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER).


RESULTS
There was no significant difference in the patients' backgrounds. The ITT analysis revealed an eradication rate of 94.6% for VPZ/AC and 86.7% for RPZ/AC. VPZ/AC cost 1155.4 Japanese yen (JPY) higher than RPZ/AC (34063.4 vs. 32908.0, JPY). CER of VPZ/AC was less than that of RPZ/AC (360.1 vs. 379.4, JPY per percent) and ICER of VPZ/AC was 147.0 JPY (1.28 Euro (EUR), 1 EUR =115 JPY) per percent.


CONCLUSIONS
VPZ/AC was more cost-effective than RPZ/AC as first-line therapy for H. pylori eradication.
a Department of Gastroenterology , Fuyoukai Murakami Hospital , Aomori , Japan.
Yusaku
Y
Kajihara
b Department of Gastroenterology , Hirosaki University Graduate School of Medicine , Hirosaki , Japan.
Tadashi
T
Shimoyama
a Department of Gastroenterology , Fuyoukai Murakami Hospital , Aomori , Japan.
Ichiro
I
Mizuki
D000328:Adult; D000658:Amoxicillin / Q000008:administration & dosage* / Q000191:economics; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D017291:Clarithromycin / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D007564:Japan; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011758:Pyrroles / Q000008:administration & dosage* / Q000191:economics; D064750:Rabeprazole / Q000627:therapeutic use; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage* / Q000191:economics
C552956:1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D011758:Pyrroles; D013449:Sulfonamides; D008795:Metronidazole; D064750:Rabeprazole; D000658:Amoxicillin; D017291:Clarithromycin
Helicobacter pylori; cost-effectiveness; eradication; rabeprazole; vonoprazan