Evaluation of the cost‐effectiveness of Helicobacter pylori eradication triple therapy vs. conventional therapy for ulcers in Japan

Abstract

Background: Helicobacter pylori eradication triple therapy with a combination of lansoprazole, amoxicillin and clarithromycin was approved in Japan in September 2000. Aim: To compare the cost‐effectiveness of this eradication therapy with conventional histamine‐2 receptor antagonist therapy in Japan. Methods: We established two Markov models for gastric and duodenal ulcers. The model design was based on the Japanese H. pylori eradication guideline and a specialist’s opinions, and the model inputs were obtained from a literature review. The models predict the direct medical costs, number of disease‐free days and cost per disease‐free day for 5 years. Results: In the gastric ulcer model, the expected total costs of eradication and conventional therapies per patient were ¥169 719 and ¥390 921, respectively; the expected numbers of disease‐free days were 1454 days and 1313 days, respectively. In the duodenal ulcer model, the expected total costs were ¥134 786 and ¥324 689, respectively; the expected numbers of disease‐free days were 1503 days and 1387 days, respectively. The sensitivity analyses showed that the results of the base case analysis were robust. Conclusions: This eradication therapy is less costly and more effective than conventional therapy for the treatment of gastric and duodenal ulcers in a Japanese medical setting.

Guidelines for the Management ofHelicobacter pyloriInfection in Japan: 2009 Revised Edition

“…High‐level evidence obtained in Japan and overseas, including several meta‐analyses, indicates that H. pylori eradication therapy inhibits the recurrence of H. pylori ‐positive gastric/duodenal ulcer and decreases complications such as bleeding [25–30]. In statistical studies, H. pylori eradication therapy inhibits recurrence and improves medical economy compared with conventional therapy [31–33]. Therefore, it is a consensus among international guidelines (including the Japanese guidelines) that unless a patient is allergic to any of the drugs for eradication therapy or has complications that could interfere with eradication, such therapy should be the first‐line treatment for H. pylori ‐positive peptic ulcer [1,34–40].…”

“…When long‐term observation of patients with reflux esophagitis is performed following H. pylori eradication, most of them remain in grade A or B of the Los Angeles Classification and their symptoms may not become more severe [169]. In patients with peptic ulcer, H. pylori eradication is still cost‐effective, even allowing for the cost of treating reflux esophagitis [32], so an increased incidence of reflux esophagitis may not be an impediment to performing eradication therapy. In Japan, there have been reports about a high incidence of reflux esophagitis in patients with corpus gastritis or hiatus hernia [167,169], so it is necessary to explain these issues to patients before eradication therapy is performed.…”

The Dramatic Spread of Diabetes Mellitus Worldwide and Influence of Helicobacter pylori

“…The efficacy of H. pylori eradication strategies, the appropriate length of treatment and the cost effectiveness, all appear controversial [13][14][15][16]. Further reports in literature have devaluated the triple therapy and suggested a quadruple one [17].…”

Antiulcerogenic benefits of herbal ingredients in ethanol-induced animal models

“…For example, in Russia, over 98% of patients with gastric ulcer experienced abdominal pain (Grebenev and Sheptulin, 1992). In USA, the annual expenditures attributed to recent ulcers amounted to $5.65 billion (Taniyama et al, 2011) while in Japan, it was estimated that the 5-year medical cost per patient ranged ¥169,719 to ¥390,921, depending on the type of medicines employed in 2001 (Ikeda et al, 2001). In 2011, total 9-month medical cost per patient ranged ¥237,467 to ¥447,377 (Taniyama et al, 2011).…”