Economic and health impacts of Helicobacter pylori eradication strategy for the treatment of peptic ulcer disease: A cost‐effectiveness analysis

Abstract

Background Most peptic ulcer cases are associated with Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti‐inflammatory drugs (NSAIDs). H. pylori eradication therapy is recommended for the treatment of H. pylori‐positive peptic ulcers. We aimed to assess and validate the cumulative economic and health effects of H. pylori eradication strategy for the treatment of peptic ulcers compared with PPI therapy strategy. Materials and Methods We developed a cohort state‐transition model for H. pylori eradication strategy and PPI therapy strategy over a lifetime horizon from a healthcare payer perspective. We targeted two hypothetical cohorts of H. pylori‐positive patients with gastric and duodenal ulcers aged 20, 30, 40, 50, 60, 70, and 80. The main outcomes were costs, quality‐adjusted life‐years (QALYs), life expectancy life‐years (LYs), incremental cost‐effectiveness ratios, ulcer recurrence cases, and ulcer‐associated deaths. One‐way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty. Results In the base‐case analysis, H. pylori eradication strategy was less costly with greater benefits than PPI therapy strategy in all age groups. Cost‐effectiveness was not sensitive to any variables in all age groups. Sensitivity analyses showed strong robustness of the results. From 2000 to 2020, H. pylori eradication strategy saved US$14.07 billion over a lifetime, increased 8.65 million QALYs and 1.23 million LYs over a lifetime, and prevented 551,298 ulcer recurrence cases and 59,465 ulcer‐associated deaths, compared with PPI therapy strategy. Conclusions H. pylori eradication strategy not only has contributed significantly to preventing ulcer recurrence and reducing ulcer‐associated deaths but also has resulted in great cost savings. All over the world, H. pylori eradication strategy is likely to have yielded a comparable magnitude of economic and health benefits, depending on the epidemiology of H. pylori‐related peptic ulcers and the healthcare environment in each country.

Efficacy and safety of seven Chinese patent medicines combined with conventional triple/quadruple therapy forHelicobacter pylori-positive peptic ulcers: a systematic review and network meta-analysis

“…Third, the RPUR was reported in only 12 of the 36 included RCTs, potentially impacting the accuracy of our findings. Fourth, it was known that factors such as patients’ age, current smoking and/or drinking habits, the locations and sizes of ulcers, antibiotic resistance of HP , various T/Q therapy regimens and recent use of non-steroidal anti-inflammatory drugs (NSAIDs) could be identified as the effect modifiers 76–78. Baseline comparisons between arms revealed no significant differences in patients’ ages or the locations and sizes of ulcers (see online supplemental table S2).…”

A Population-Based Helicobacter pylori Eradication Strategy Is More Cost-Effective than Endoscopic Screening

“…The superiority of HP eradication strategy is mainly due to the high HP infection rates in the Japanese population, the evidence that HP eradication therapy for HP-positive patients reduces the incidence of gastric cancer by 46%, and the low cost of HP testing and eradication therapy compared to the cost of gastric cancer treatment. We previously showed that HP eradication strategy is more cost-effective than no screening [ 36 , 37 ], upper gastrointestinal series [ 38 ], and endoscopic screening [ 38 ] for gastric cancer screening and that HP eradication strategy is more cost-effective than the proton pump inhibitors therapy strategy [ 39 ] for the management of peptic ulcers in high-risk populations. This study further demonstrated the definite cost-effectiveness advantage of HP eradication strategy over endoscopic screening, even when considering various intervals or the cost of follow-up endoscopy after successful HP eradication therapy at age 50 years or older.…”

Gastrointestinal bleeding among 151 patients undergoing maintenance hemodialysis for end-stage renal failure: A 5-year follow-up study

“…[8][9][10][11][12]23] It is well established that eradication therapy for H. pyloriinfected patients prevents peptic ulcer onset. [25,26] Vascular lesions primarily cause upper GI bleeding in patients with eradicated H pylori infection, whereas upper GI bleeding in patients without a history of H pylori infection is primarily attributed to ulcers and erosions. Previous studies have indicated that the prophylactic prescription of proton pump inhibitors prevents upper GI bleeding.…”