Helicobacter pylori eradication regimens in an antibiotic high-resistance European area: A cost-effectiveness analysis.
Helicobacter
; 25(1): e12666, 2020 Feb.
Article
em En
| MEDLINE
| ID: mdl-31692137
ABSTRACT
INTRODUCTION:
Helicobacter pylori infection (H pylori-I) affects more than half of the global population and consists an important burden to public health and healthcare expenditures, by contributing to many diseases' pathogenesis.AIM:
This study aimed to evaluate the current nonbismuth quadruple eradication regimens in a high antibiotic resistance area, such as Greece, concerning their cost-effectiveness, especially during financial crisis period. MATERIALS ANDMETHODS:
Eight hundred and nine patients who received eradication treatment against H pylori-I were included to evaluate five different regimens, using amoxicillin, clarithromycin, and metronidazole as antibiotics and one proton-pump inhibitor, based on their current eradication rates. Regimes compared 10-day concomitant use of (a) pantoprazole or (b) esomeprazole; 10-day sequential use of (c) pantoprazole or (d) esomeprazole; and 14-day hybrid using esomeprazole. Cost-effectiveness analysis ratio (CEAR) and incremental cost-effectiveness ratios were calculated taking into account all direct costs and cases who needed second-line treatment. Additionally, sensitivity analysis was performed to predict all potential combinations.RESULTS:
Ten-day concomitant regimen with esomeprazole was characterized by the lowest CEAR (179.17) followed by the same regimen using pantoprazole (183.27). Hybrid regimen, although equivalent in eradication rates, was found to have higher CEAR (187.42), whereas sequential regimens were not cost-effective (CEAR 204.12 and 216.02 respectively).DISCUSSION:
This is the first study evaluating the cost-effectiveness of H pylori-I treatment regimens in a high clarithromycin-resistance (≈26.5%) European area, suggesting the 10-day concomitant regimen with generics using esomeprazole 40 mg as the most appropriate one. National and regional guidelines should include cost-effectiveness in their statements, and further studies are required to clarify the necessity of a wide "test and treat" policy for H pylori-I.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por Helicobacter
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Farmacorresistência Bacteriana
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Antibacterianos
Tipo de estudo:
Clinical_trials
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Guideline
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Health_economic_evaluation
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Observational_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Helicobacter
Assunto da revista:
BACTERIOLOGIA
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Grécia