Cost-effectiveness Analysis Comparing Vonoprazanbased Triple Therapy with Proton Pump Inhibitorbased Therapy in the Treatment of Helicobacter pylori Infection in Thailand

Abstract

Objective: Helicobacter pylori (H. pylori) infection is one of the leading causes of gastrointestinal diseases such as dyspepsia, peptic ulcers. Thailand has a 45.9% prevalence of the infection and an increasing rate of resistance to clarithromycin, leading to standard treatments being less successful. Vonoprazan represents a novel drug offering a new treatment regimen. Although vonoprazan has been available in Thailand since 2019, its cost-effectiveness has not been studied previously.Materials and Methods: This study analysed the cost-effectiveness of vonoprazan-based triple therapy compared with PPI-based therapy, in treating clarithromycin resistant H. pylori, by using the markov model from a societal perspective.Results: The total cost of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 784,932.08 baht, 783,863.65 baht and 783,874.55 baht respectively. The quality-adjusted life years (QALYs) of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 25.1118 years, 25.1147 years and 25.1054 years respectively. The cost-effectiveness ratio (CER) of vonoprazanbased triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 31,257.50 baht/ QALYs, 31,211.35 baht/QALYs and 31,223.34 baht per QALYs respectively.Conclusion: Therefore, levofloxacin-PPI based triple therapy was found to be the most cost-effective regimen and the dominant strategy compared with concomitant-PPI or vonoprazan-based triple therapy. It provided higher QALYs and lower treatment costs. Levofloxacin-PPI based triple therapy should be the first choice of an alternative strategy in treating clarithromycin-resistant H. pylori. The results of this study can be used by policymakers to help inform their decisions.

Cost-Effectiveness of Vonoprazan-Based and Rifabutin-Based vs Other Regimens as First-Line Treatment of Helicobacter pylori Infection in the United States

“…In a retrospective observational study with a follow-up period of 1 year, Kajihara et al (57) compared vonoprazan triple therapy with the clarithromycin triple regimen (containing the PPI rabeprazole, amoxicillin, and clarithromycin) in Japan and found that the vonoprazan-based regimen was more costeffective than clarithromycin triple. Lertsirimunkong et al (58) evaluated vonoprazan triple therapy, levofloxacin triple therapy, and concomitant therapy, using a Markov model over a lifetime horizon, and found that levofloxacin triple therapy was the most cost-effective from the societal perspective of Thailand. This study examined more treatment alternatives than the previous This study has important implications for more than 114 million individuals in the United States with H. pylori, clinicians, and policymakers, offering insight into the combination of efficacy and cost on the overall value of H. pylori eradication regimens.…”

“…Within the past 2 decades in the United States, this study is the first to report on the cost-effectiveness of H. pylori eradication regimens, and to the best of our knowledge, no previous study assessed the cost-effectiveness of the rifabutin triple therapy regimen. Two previous studies, conducted in Asian countries, examined the potential cost-effectiveness of vonoprazan-based H. pylori eradication regimens and yielded mixed findings (57,58). In a retrospective observational study with a follow-up period of 1 year, Kajihara et al (57) compared vonoprazan triple therapy with the clarithromycin triple regimen (containing the PPI rabeprazole, amoxicillin, and clarithromycin) in Japan and found that the vonoprazan-based regimen was more cost-effective than clarithromycin triple.…”