What is the optimal length of proton pump inhibitor‐based triple therapies for H. pylori? A cost‐effectiveness analysis

Abstract

Although triple therapies with a proton pump inhibitor and two antibiotics are the most widely accepted treatment for Helicobacter pylori infection, there is no consensus on how long this treatment should be maintained. Seven-day schedules are preferred in many settings, but in the USA 10 and 14-day therapies are routinely employed. 1±5 Even in Europe, where 7-day therapies are widely used, a recent consensus report recommended 7±10 days treatment, possibly because of increasing evidence that the ef®cacy of 7-day schedules was less than 90%. 6±10 Many studies have reported comparisons of short (7-day) and extended (10±14-day) schedules. 11±22 Most reported a non-signi®cant increase in eradication rates with longer therapies. 11, 13, 15±17, 19, 23±25 The results of a recent meta-analysis on the ef®cacy of different lengths of triple therapy show a moderate increase in eradication rates with longer schedules, although the increase was only signi®cant when comparing 7±14-day treatments. 26 However, the eradication rate of ®rst-line therapy is not the only factor that should be taken into account when choosing between 7-day and 10-or 14-day therapies. Can we justify doubling the costs of drug therapy and increasing discomfort in all our patients to avoid a second treatment in 5±10% of subjects? Could ®rst-line 7-day triple therapy in SUMMARY Background: Triple therapy with a proton pump inhibitor, clarithromycin and amoxicillin is widely used for H. pylori infection. The appropriate length of treatment remains controversial. Aim: To determine whether length of treatment has an impact on the cost-effectiveness of triple therapy. Methods: The study took the form of a cost-effectiveness analysis spanning 2 years. The perspective was societal and the setting, ambulatory care. Subjects were Helicobacter pylori-positive patients with a duodenal ulcer. The triple therapy trials spanned 7, 10 or 14 days and the main outcome measures were cost per patient and marginal cost for additional cured patient calculated for a low cost-of-care setting (Spain), for a high-cost setting

Pharmacoeconomic comparison of Helicobacter pylori eradication regimens

“…This study also showed that 7-day LAC therapy was more cost-effective than 14-day OAC therapy. Many studies have reported that 7-day therapies were the most costeffective strategies [2,19,30,31]. The duration of eradication therapy is still controversial in Europe and other parts of the world, 7-day triple regimens are used, whereas guidelines from the United States recommend 10-14 days of therapy [32].…”

Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report

“…71 Few studies have compared the cost effectiveness of these different strategies. 72 Numerous studies with PPI triple therapy for seven days, mainly from European countries, confirm that this is still a valid duration for this treatment. 70 Bismuth-containing quadruple therapy (10 or 14 days) is an option for the first line treatment.…”

Update on non-bismuth quadruple (concomitant) therapy for eradication of Helicobacter pylori

“…The real benefit of a highly effective first-line therapy is much greater than the raw percentage data suggest 78. As safety is similar and the increase in costs relatively low, it seems reasonable to recommend the length of treatment achieving maximal cure rates (10 days), even though the expected improvements will be moderate.…”