Pylori Eradication Strategies Research Articles

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

BackgroundMost 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 MethodsWe 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.ResultsIn 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.

The increasing antimicrobial resistance of Helicobacter pylori in Iran: A systematic review and meta-analysis.

Antimicrobial resistance of Helicobacter pylori can result in eradication failure. Metadata on the antimicrobial resistance of H pylori in Iran could help to formulate H pylori eradication strategies in Iran. A systematic review was performed after searching in MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Library. A meta-analysis was performed, and a comparison of the rates between children and adults; time periods (1999-2010, 2011-2016, 2017-2019); and the methods used was carried out. A total of 66 studies investigating 5936 H pylori isolates were analyzed. The weighted pooled resistance (WPR) rates were as follows: clarithromycin 21% (95% CI 16-26), metronidazole 62% (95% 57-67), clarithromycin in combination with metronidazole 16% (95% CI 10-23), ciprofloxacin 24% (95% CI 15-33), levofloxacin 18% (95% CI 9-30), erythromycin 29% (95% CI 12-50), furazolidone 13% (95% CI 4-27), tetracycline 8% (95% CI 5-13), and amoxicillin 15% (95% CI 9-22). During the three time periods, there was an increased resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline (P˂.05). Furazolidone and a clarithromycin/metronidazole combination had the higher resistance rates in children (P˂.05). An increasing rate of resistance to amoxicillin, clarithromycin, ciprofloxacin, furazolidone, and tetracycline in Iranian H pylori isolates was identified. In children, the resistance to furazolidone and a combination of clarithromycin and metronidazole is higher compared to adults. As a stable, high resistance to metronidazole was found in children and adults in all Iranian provinces, we suggest that metronidazole should not be included in the Iranian H pylori eradication scheme.

Abstract B008: Implementing electronic health records-based intervention tools in a large NYC healthcare system to facilitate H. pylori eradication strategies for gastric cancer prevention for at-risk Chinese American immigrant patients

Abstract Background: Gastric cancer is the third most common cause of cancer mortality worldwide. Chinese Americans experience a disproportionate burden of gastric cancer mortality. The bacterium Helicobacter pylori (H. pylori) is the strongest risk factor for gastric cancer; H. pylori eradication through triple antibiotic therapy is the most effective prevention method. Clinician adherence to the American College of Gastroenterology H. pylori treatment guidelines is not high. Medication adherence to the complex treatment regimen is challenging, especially for Chinese New Yorkers for whom 61% have limited English proficiency and low health literacy. Purpose of the Study: Working with an advisory coalition of community and health care safety net provider stakeholders, we developed a health-systems level intervention using electronic health record (EHR)-based tools to facilitate H. pylori treatment strategies for gastric cancer prevention. Methods: We used a mixed methods approach to inform EHR tool development, including: 1) a comprehensive scoping review of the peer reviewed and grey literature on gastric cancer prevention programs for Chinese Americans; 2) 4 site workflow analyses, which consisted of ethnographic observations and key informant interviews with 5 providers for contextual data on organizational workflow, culture and practice; and 3) 15 key informant interviews with community-based stakeholders and former patients. Results: Findings indicated the lack of culturally and linguistically tailored H. pylori and gastric cancer prevention materials. Using an iterative process, we developed 3 EHR-based tools: 1) a H. pylori medication order set for the most common first and second-line therapies; 2) basic health education materials for the patient in English and Chinese; and 3) a follow-up reminder for testing in 2 months to the patient’s primary care physician. Barriers and facilitators to implementation will be shared, including findings from utilization reports on patterns of use. Conclusion: There is a need to integrate system-wide EHR-based tools for underserved, vulnerable communities to enhance and sustain evidence-based practices for treatment adherence and cancer prevention to reduce H. pylori-related gastric cancer disparities for high-risk populations. Citation Format: Simona Kwon, Yi-Ling Tan, Janet Pan, Devin Mann, Sara Chokshi, Renee Williams, QiuQu Zhao, Benyam Hailu, Chau Trinh-Shevrin. Implementing electronic health records-based intervention tools in a large NYC healthcare system to facilitate H. pylori eradication strategies for gastric cancer prevention for at-risk Chinese American immigrant patients [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B008.

Global whole family based-Helicobacter pylori eradication strategy to prevent its related diseases and gastric cancer.

Helicobacter pylori (H. pylori) infects approximately 50% of the world population. The multiple gastrointestinal and extra-gastrointestinal diseases caused by H. pylori infection pose a major healthcare threat to families and societies; it is also a heavy economic and healthcare burden for countries that having high infection rates. Eradication of H. pylori is recommended for all infected individuals. Traditionally, “test and treat” and "screen and treat" strategies are available for various infected populations. However, clinical practice has noticed that these strategies have some shortfalls and may need refinement, mostly due to the fact that they are not easily manageable, and are affected by patient compliance, selection of treatment population and cost-benefit estimations. Furthermore, it is difficult to control infections from the source, therefore, development of additional, compensative strategies are encouraged to solve the above problems and facilitate bacteria eradication. H. pylori infection is a family-based disease, but few studies have been performed in a whole family-based approach to curb its intra-familial transmission and the development of related diseases. In this work, a third, novel whole family-based H. pylori eradication strategy is introduced. This approach screens, identifies, treats and follows up on all H. pylori-infected individuals in entire families to control H. pylori infection among family members, and reduce its long-term complications. This strategy is high-risk population-oriented, and able to reduce H. pylori spread among family members. It also has good patient-family compliance and, importantly, is practical for both high and low H. pylori-infected communities. Future efforts in these areas will be critical to initiate and establish healthcare policies and management strategies to reduce H. pylori-induced disease burden for society.

Recurrence of Helicobacter pylori infection in Bolivian children and adults after a population-based "screen and treat" strategy.

Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based "screen and treat" eradication program. We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection. We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78-84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8-15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10-29) in persons <5 years, 20% (95% CI: 10-29) in 5-9 years, 8% (95% CI: 1-15) in 10-14 years, and 8% (95% CI: 4-12) in persons ≥15 years. Compared with the referent population, those ≥15 years, recurrent infections were significantly more likely in children <5 years (odds ratios [OR] 2.7, 95% CI: 1.2-5.8) and 5-9 years (OR 2.7, 95% CI: 1.4-5.1). Children <10 years had high H. pylori recurrence rates following a population-based screen and treat program; this H. pylori eradication strategy may not be feasible in high-prevalence, low-income settings.

Abstract A05: Economic benefit of Helicobacter pylori screening and eradication treatment for the prevention of gastric cancer

Abstract Background: The association between Helicobacter pylori infection and gastric cancer, which remains a major health problem in Japan, is well established. Detecting infected persons by simple testing and administering eradication treatment might be an effective means to prevent gastric cancer. However, when considering mass screening, the economic benefit must be proven. The purpose of this study is to predict the economic benefit of an H. pylori eradication strategy as a method to prevent of gastric cancer. Methods: Using data in the literature and demographic statistics, the number of persons infected with H. pylori, the infection rate, and the number of those who developed gastric cancer by H. pylori were estimated. Then, a cost benefit analysis of H. pylori screening and eradication treatment was done by using data from the patient survey, basic survey on wage structure, and list of medical fees. The costs are those of screening and eradication treatment, and the benefits are fees that would otherwise have been used for the treatment of gastric cancer, time lost that would have been from work, and the economic loss due to premature death caused by gastric cancer. Results: The infection rates at 10-19, 40-49 and 60-69 years of age were 2.5%, 28.1% and 52.6%, respectively for the year 2010, and the total number of infected persons was estimated to be 37.3 million (29.1% of the whole population). The number of persons who would be at risk of gastric cancer during their lives due to H. pylori infection was 750,000 when we assumed 2% as the risk of gastric cancer by H. pylori infection. The numbers of infected people in 2020, 2030 and 2050 were projected to be 31.3 million, 24.5 million and 11.0 million, respectively. The numbers of persons who would be at risk of gastric cancer due to the H. pylori infection in 2020, 2030 and 2050 would be 630,000, 490,000 and 220,000, respectively. When the subjects of screening and eradication treatment are assumed to be from 16 to 39 years old, and when the response rates of screening and eradication treatment are set at 30% and 60%, respectively, the cost in 2010 would be $841 million. In the case of 20% and 40%, the cost would be $469 million. In the case of 40% and 70%, it would be $1.19 billion. However, the benefit would be $778 million, since the total fee for the treatment of gastric cancer would be $91 million and the loss of profits $686 million. Therefore, the cost benefit ratios would be 0.9, 1.6 and 0.7, respectively. When the response rates of screening and eradication treatment are low, the cost is at a reasonable level but requires more time to be recovered. When the response rates are high, the cost is huge but is recovered very quickly. Conclusions: The infection rate of H. pylori is gradually decreasing in younger people and it is necessary to consider the trend in the number of the infected people, the response rates of screening and that of eradication treatment for the economic evaluation. Citation Format: Nobuo Koinuma. Economic benefit of Helicobacter pylori screening and eradication treatment for the prevention of gastric cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A05.

Helicobacter pylori eradication improved dyspepsia symptoms

(2002) BMJ 324, 1012; Chiba N, Veldhuyzen van Zanten SJ, Sinclair P, et al. . Treating Helicobacter pylori infection in primary care patients with uninvestigated dyspepsia: the Canadian adult dyspepsia...

The cost-effectiveness of competing strategies for the prevention of recurrent peptic ulcer hemorrhage

OBJECTIVE: Several strategies exist for the prevention of recurrent ulcer-related hemorrhage, yet the cost-effectiveness has not been evaluated and remains uncertain. The aim of this study was to compare the cost-effectiveness of competing management strategies considering both nonsteroidal anti-inflammatory drugs status and the accuracy of Helicobacter pylori ( H. pylori) testing. METHODS: Decision analysis was used to compare the cost-per-recurrent hemorrhage prevented for 11 strategies over 1 yr. Clinical and costs estimates were derived from a systematic review of the medical literature and the Medicare Fee Schedule and Drug Topics Redbook. Sensitivity analyses were performed for important variables. RESULTS: The test/retest eradication strategy with maintenance proton pump inhibitor therapy for H. pylori-negative patients was most effective (prevention of recurrence in 96.0%). The test/retest eradication strategy with maintenance histamine-2 receptor antagonist therapy for H. pylori-negative patients was least costly ($1070). The test/retest strategies were dominant with average cost-effectiveness ratios of $1118–1310/recurrent hemorrhage prevented with maintenance antisecretory therapy. The average cost-effectiveness ratios for “selective” H. pylori eradication strategies with maintenance antisecretory therapy were $1263–1673. The model was robust to varying estimates over prespecified ranges. CONCLUSIONS: Test/retest strategies for H. pylori are cost-effective for the prevention of recurrent ulcer-related hemorrhage because they maximize H. pylori detection and eradication, resulting in fewer recurrent hemorrhages and fewer patients requiring antisecretory therapy.

Is Helicobacter pylori eradication a cost-effective treatment of duodenal ulcer disease?

Treatment strategies aimed at eradicating Helicobacter pylori have shown positive results in the management of duodenal ulcer disease. Several cost-effectiveness studies comparing these regimens with traditional therapy have recently been conducted, and results are discussed in this review. Cost comparisons of different treatment strategies cannot be performed without first identifying whether the cost of ulcer diagnosis is included in the study. Assuming that only 20% of patients with dyspepsia actually have ulcer disease, costs may vary, depending on the study population. Importantly, treatment costs should not be compared between a patient population with confirmed ulcer disease and one without confirmed disease. In patients with confirmed ulcer disease, studies consistently show that H. pylori eradication strategies are associated with greater efficacy and lower costs than traditional treatment, and are therefore a more cost-effective alternative to standard therapy. Although all models used in the cost-effectiveness analyses assume that patients discontinue treatment following successful eradication of the microorganism, in clinical practice some patients continue antisecretory treatment beyond this period. Thus, savings as a result of H. pylori eradication may be less substantial than indicated in cost-effectiveness studies.

Economic evaluation in gastrointestinal disease.

Safety and efficacy are not the only parameters of interest in the choice of medical technology--costs are playing an increasingly important role. There is growing interest in 'value for money', which can be assessed economically by comparing the costs and consequences of alternative courses of action. A number of different economic evaluation methods may be used: cost-minimization (only costs examined with no consideration given to consequences); cost-effectiveness (in which a unidimensional clinical outcome is assessed, for example, life-years gained); cost-utility (multidimensional outcomes measured, for example quantity and quality of life); and cost-benefit (where outcome is considered in monetary terms). Ulcer disease offers several examples of how economic evaluation can be used to address issues related to efficiency and value for money in healthcare. In a study of reflux oesophagitis, omeprazole was shown to be more cost-effective than ranitidine in a 12-week treatment study. With omeprazole the costs were lower and the effectiveness better than with the H2-receptor antagonist. In a later study the cost-effectiveness of omeprazole and ranitidine are compared for both intermittent and maintenance treatment in reflux oesophagitis. Using a Markov chain approach, Swedish cost data and studying a time period of 12 months, it found that omeprazole is both more effective in providing healthy days and less costly than ranitidine for both treatment strategies. The comparison between intermittent treatment and maintenance treatment with omeprazole shows that the latter is more effective but also more costly. It is concluded that the relative cost-effectiveness of omeprazole maintenance treatment increases with the risk of relapse when off treatment, the severity of symptoms following relapse, and the value of healthy days, i.e. days free from reflux oesophagitis. A model analysis comparing Helicobacter pylori eradication with conventional treatments in patients with duodenal ulcer disease has shown H. pylori eradication to be cost-effective when compared with either episodic therapy using omeprazole or maintenance therapy with ranitidine. The study used a Markov chain approach, and included the cost of treatment, in Swedish crowns, in a Swedish primary care setting over a period of 5 years. In the analysis, patients receiving conventional therapy were initially healed with omeprazole, 20-40 mg once daily. Following healing patients were either treated with further courses of omeprazole upon relapse or were given maintenance treatment with ranitidine, 150 mg once daily. The patients who were assigned to the H. pylori eradication therapy group were initially given an H. pylori test. Those patients who proved positive for the bacterium received omeprazole, 20 mg twice daily, plus amoxicillin, 2000 mg daily in divided doses, for 2 weeks, followed by omeprazole, 20 mg once daily, for a further 2 weeks to ensure healing. Patients who were H. pylori-negative were assigned to receive either episodic or maintenance therapy as described above. The model assumption applied in the H. pylori eradication group was that, following successful healing and H. pylori eradication, virtually all patients were cured and experienced no relapse during the following 5 years. by contrast, almost all the patients assigned to episodic therapy relapsed, and during maintenance therapy with H2-receptor antagonists, most patients experienced at least one relapse. Although H. pylori eradication resulted in initial higher costs than the alternative strategies, it reduced the risk of recurrence and for most patients there were no future costs. The investment therefore paid off within a relatively short period of time. Even when unfavourable assumptions were made, such as an H. pylori eradication rate of only 50%, the H. pylori eradication strategy had a pay-off period of less than 1.3 years compared with maintenance treatment, and 3 years compared with episodic

Cost-effectiveness of Helicobacter pylori Eradication for the Long-term Management of Duodenal Ulcer in Canada

A 1994 National Institutes of Health consensus panel recommended that eradication of Helicobacter pylori should be first-line therapy for persons with duodenal ulcer. To assess the cost-effectiveness of H pylori eradication relative to alternative pharmacologic strategies in the long-term management of persons with confirmed duodenal ulcer. Decision analysis model to estimate expected costs and symptomatic ulcer recurrences during a 12-month period for three general treatment strategies: (1) immediate H pylori eradication; (2) H pylori eradication at first ulcer recurrence; and (3) continuous maintenance therapy with a histamine2 receptor antagonist (ranitidine hydrochloride). Two H pylori eradication therapies were compared: classic triple therapy and omeprazole plus amoxicillin. Probabilities for ulcer recurrence are by meta-analysis of published randomized trials. Health care resources used in the management of duodenal ulcer recurrence were by expert physician panel. All costs are in 1993 Canadian dollars. Duodenal ulcer recurrence at 6 months (symptomatic and asymptomatic) with placebo was 65.4% and 12.8% with maintenance ranitidine therapy. Where eradication of H pylori was successful (85% of patients), the ulcer recurrence rate to 12 months was 3.7%. Treatment with ranitidine and triple therapy to eradicate H pylori on first presentation has an expected 1-year cost of $253 with 15 symptomatic recurrences per 100 patients; H pylori eradication by omeprazole plus amoxicillin had similar expected costs ($272) and outcomes (15 recurrences per 100 patients). Both of these early H pylori eradication strategies were dominant (less costly with same or better outcomes) over intermittent or continuous maintenance ranitidine therapy or delayed (after first recurrence) H pylori eradication. Our analysis provides economic evidence in support of the recent guidance that for persons with duodenal ulcer, early attempts to eradicate H pylori are recommended.