Cost-effectiveness analysis of two Routine therapeutic methods to Helicobacter pylori eradication: A Persian cohort-based study Cost-effectiveness analysis of Helicobacter pylori eradication
Gastroenterology and Hepatology from Bed to Bench,
26 April 2021
Background: Because of the importance of Helicobacter pylori (H. pylori) eradication on gastric cancer prevalence and costs, economic analysis of the eradication methods is essential for the health systems.
Purpose of the study: This study aimed to analyze the cost-effectiveness of two routine therapeutic methods to H. pylori eradication in Iran.
Methods: We conducted a cross-sectional study on 7,496 participants with positive Hepadnaviridae (HPsAg) test results for H. pylori, where 6,163 of them were treated with Furazolidone (Group A), and 1,333 participants were treated with Clarithromycin (Group B). GP visits, medications, and HPsAg cost as direct costs and absence from work and transportation as indirect costs collected by the researcher-made questionnaire. Indirect costs calculated based on face-to-face interviews with 365 patients of the Persian Cohort Center. Successful eradication of H. pylori infection (negative HPsAg) defined as the effectiveness of the interventions. Incremental Cost-Effectiveness Ratio (ICER) used to compare the overall results.
Results: The total direct cost of H. pylori for groups A and B were estimated at 13.7 and 5.83 billion IRR, respectively. The highest and lowest percentages of total costs were the cost of diagnostic services and the time cost, respectively. There was a significant difference between the two groups in drug costs (p<0.001). The effect ratio for Groups A and B was 85.93% and 96.54%, respectively. Cost per effectiveness for Clarithromycin (CE=3,250,170 IRR) was higher than Furazolidone (CE=2,988,488 IRR), and ICER showed that there is a need for 5.1 Million IRR to eradication H. pylori per participant.
Conclusion: Base on the results, Furazolidone was cost-effectiveness than Clarithromycin for H. pylori treatment. Therefore, due to the high prevalence of H. pylori and the economic conditions of the health system in Iran, Furazolidone can be a cost-effective choice between the two conventional treatment methods with considering the results of further research and possible side effects.
Keywords: Cost-Effectiveness, Helicobacter Pylori, Eradication, Furazolidone, Clarithromycin
- Cost-Effectiveness, Helicobacter Pylori, Eradication, Furazolidone, Clarithromycin
2. Zhang R-G, Duan G-C, Fan Q-T, Chen S-Y. Role of Helicobacter pylori infection in pathogenesis of gastric carcinoma. World journal of gastrointestinal pathophysiology. 2016;7(1):97.
3. Prado IA, Velasco JVR, Lopez CG, Gutierrez SU, Bonilla GM, Diaz VG et al. AB1128 Helicobacter pylori in systemic lupus erythematosus its association with endoscopic and histopathologic findings. BMJ Publishing Group Ltd; 2017.
4. Tameshkel FS, Niya MHK, Kheyri Z, Azizi D, Roozafzai F, Khorrami S. The evaluation of diagnostic and predictive values of helicobacter pylori stool antigen test in Iranian patients with dyspepsia. Iranian journal of pathology. 2018;13(1):38.
5. Hooi JK, Lai WY, Ng WK, Suen MM, Underwood FE, Tanyingoh D et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153(2):420-9.
6. Kienesberger S, Perez-Perez GI, Olivares AZ, Bardhan P, Sarker SA, Hasan KZ et al. When is Helicobacter pylori acquired in populations in developing countries? A birth-cohort study in Bangladeshi children. Gut microbes. 2018;9(3):252-63.
7. Zamani M, Ebrahimtabar F, Zamani V, Miller W, Alizadeh‐Navaei R, Shokri‐Shirvani J et al. Systematic review with meta‐analysis: the worldwide prevalence of Helicobacter pylori infection. Alimentary pharmacology & therapeutics. 2018;47(7):868-76.
8. Tareen A, Butt T, Ali B. Helicobacter pylori infection in patients with chronic urticaria and dyspepsia, experience from a developing country. Journal of Pakistan Association of Dermatology. 2017;26(3):206-13.
9. Moosazadeh M, Lankarani KB, Afshari M. Meta-analysis of the prevalence of Helicobacter pylori infection among children and adults of Iran. International journal of preventive medicine. 2016;7.
10. Beard JR, Officer A, De Carvalho IA, Sadana R, Pot AM, Michel J-P et al. The World report on ageing and health: a policy framework for healthy ageing. The lancet. 2016;387(10033):2145-54.
11. Zahirian Moghadam T, Raeissi P, Jafari-Sirizi M. Analysis of the Health Sector Evolution Plan from the perspective of equity in healthcare financing: a multiple streams model. International Journal of Human Rights in Healthcare. 2018.
12. Zandian H, Takian A, Rashidian A, Bayati M, Moghadam TZ, Rezaei S et al. Effects of Iranian economic reforms on equity in social and healthcare financing: A segmented regression analysis. Journal of Preventive Medicine and Public Health. 2018;51(2):83.
13. Mahdavi M, Parsaeian M, Jaafaripooyan E, Ghaffari S. Recent Iranian health system reform: an operational perspective to improve health services quality. International journal of health policy and management. 2018;7(1):70.
14. Veisani Y, Delpisheh A. Survival rate of gastric cancer in Iran; a systematic review and meta-analysis. Gastroenterology and hepatology from bed to bench. 2016;9(2):78.
15. Mazdaki A, Ghiasvand H, Asiabar AS, Naghdi S, Aryankhesal A. Economic evaluation of test-and-treat and empirical treatment strategies in the eradication of Helicobacter pylori infection; A Markov model in an Iranian adult population. Medical journal of the Islamic Republic of Iran. 2016;30:327.
16. Almasi Z, Rafiemanesh H, Salehiniya H. Epidemiology characteristics and trends of incidence and morphology of stomach cancer in Iran. Asian Pacific journal of cancer prevention. 2015;16(7):2757-61.
17. Han Y, Yan T, Ma H, Yao X, Lu C, Li Y et al. Cost-Effectiveness Analysis of Helicobacter pylori Eradication Therapy for Prevention of Gastric Cancer: A Markov Model. Digestive diseases and sciences. 2019:1-10.
18. Omata F, Shimbo T, Ohde S, Deshpande GA, Fukui T. Cost-Effectiveness Analysis of Helicobacter pylori Diagnostic Methods in Patients with Atrophic Gastritis. Gastroenterology research and practice. 2017;2017.
19. Seko T, Tachi T, Hatakeyama H, Noguchi Y, Teramachi H. Cost‐effectiveness analysis and effectiveness of pharmacist‐managed outpatient clinics in Helicobacter pylori eradication therapy. International journal of clinical practice. 2019;73(6):e13349.
20. Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56(6):772-81.
21. Mohammadi M, Attaran B, Malekzadeh R, Graham DY. Furazolidone, an underutilized drug for H. pylori eradication: lessons from Iran. Digestive diseases and sciences. 2017;62(8):1890-6.
22. Eshraghian A. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: a systematic review of prevalence and risk factors. World journal of gastroenterology: WJG. 2014;20(46):17618.
23. Soltani J, Amirzadeh J, Nahedi S, Shahsavari S. Prevalence of helicobacter pylori infection in children, a population-based cross-sectional study in west iran. Iranian journal of pediatrics. 2013;23(1):13.
24. Thomson Reuters. Physicians' Desk Reference. 2009 https://www.amazon.com/Physicians-Desk-Reference-Electronic-Library/dp/1563637251.
25. Khademi F, Poursina F, Hosseini E, Akbari M, Safaei HG. Helicobacter pylori in Iran: A systematic review on the antibiotic resistance. Iranian journal of basic medical sciences. 2015;18(1):2.
26. Treiber G. The influence of drug dosage on Helicobacter pylori eradication: a cost-effectiveness analysis. American Journal of Gastroenterology. 1996;91(2).
27. Fatahi E. Comparison of Helicobacter pylori eradication with four drug regimens in dyspeptic patients. Journal of Yazd University of Medical Sciences. Journal of Yazd University of Medical Sciences. 2016;2(1):1-12.
28. Nie Y, Li Y, Wu H, Sha W, Du H, Dai S et al. Colloidal Bismuth Pectin: An Alternative to Bismuth Subcitrate for the Treatment of Helicobacter pylori–Positive Duodenal Ulcer. Helicobacter. 1999;4(2):128-34.
29. Arkkila PE, Seppälä K, Kosunen TU, Haapiainen R, Kivilaakso E, Sipponen P et al. Eradication of Helicobacter pylori improves the healing rate and reduces the relapse rate of nonbleeding ulcers in patients with bleeding peptic ulcer. The American journal of gastroenterology. 2003;98(10):2149-56.
30. Aminian K. Comparison of three-drug, four-drug and two different Sequential regimens in the treatment of first-line Helicobacter pylori infection. Iranian Journal of Infectious and Tropical Diseases. 2009;15(48):7-12.
31. Ghosh P, Kandhare AD, Gauba D, Raygude KS, Bodhankar SL. Determination of efficacy, adverse drug reactions and cost effectiveness of three triple drug regimens for the treatment of Helicobacter pylori infected acid peptic disease patients. Asian Pacific Journal of Tropical Disease. 2012;2:S783-S9.
32. Miura S, Hokari R. Seeking an optimal eradication therapy for Helicobacter pylori infection. Journal of gastroenterology and hepatology. 2012;27(1):7-9.
33. Nash C, Fischbach L, van Zanten SV. What are the global response rates to Helicobacter pylori eradication therapy? Canadian Journal of Gastroenterology and Hepatology. 2003;17(Suppl B):25B-9B.
34. Briggs A, Sculpher M, Logan R, Aldous J, Ramsay M, Baron J. Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age. BMJ. 1996;312(7042):1321-5.
35. Ikeda S, Tamamuro T, Hamashima C, Asaka M. Evaluation of the cost‐effectiveness of Helicobacter pylori eradication triple therapy vs. conventional therapy for ulcers in Japan. Alimentary pharmacology & therapeutics. 2001;15(11):1777-85.
36. You J, Lau W, Lee I, Yung M, Ching J, Chan F et al. Helicobacter pylori eradication prior to initiation of long-term non-steroidal anti-inflammatory drug therapy in Chinese patients-a cost-effectiveness analysis. International Journal of Clinical Pharmacology & Therapeutics. 2006;44(4).
37. Fischbach L, Van Zanten S, Dickason J. Meta‐analysis: the efficacy, adverse events, and adherence related to first‐line anti‐Helicobacter pylori quadruple therapies. Alimentary pharmacology & therapeutics. 2004;20(10):1071-82.
Table 1: Baseline demographic characteristics of participants in two groups with H-P in north-west of Iran.
Demographic characteristics Group A Group B P-Value
Total Subjects 6163 1333 -
Age mean (years) 49.11 50.87 <0.001
Age Groups, % <0.001
<40 18.6 11.5
40-44 18.1 14.2
45-49 18.4 19.6
50-54 16.1 20.7
55-59 13.6 17.1
60+ 15.1 17
Female 52.1 53.2
Group A: Amoxicillin 500 + Omeprazole 20 + Bismuth 120 + Furazolidone 100
Group B: Amoxicillin 500 + Omeprazole 20 + Bismuth 120 + Clarithromycin 500
Table 2. Average and Total Cost of two methods of H-Pylori elimination in Ardabil (North-west of Iran), 2018-2019
Service Item Group A Group B
Mean Cost Total Cost % Mean Cost Total Cost %
Visiting by GP 245000 1,509,935,000 9.5 245000 326,585,000 7.9
Diagnostic tests Pre intervention 545000 3,358,835,000 21.2 545000 726,485,000 17.5
Post-intervention 545000 3,358,835,000 21.2 545000 726,485,000 17.5
Medication & Drugs Amoxicillin Cap 173600 1,069,896,800 6.8 173600 231,408,800 5.6
Omeprazole cap 61600 379,640,800 2.4 61600 82,112,800 2.01
Bismuth tab 246400 1,518,563,200 9.6 246400 328,451,200 7.9
Furazolidone tab 48000 295,824,000 1.9 - - -
Clarithromycin tab - - - 613200 817,395,600 19.7
Transportation Costs 198,650 1,224,279,950 7.7 178,650 238,140,450 5.7
Time costs (Absence from work) 506,850 3,123,716,550 19.7 511,714 682,114,762 16.4
Total Costs 2,570,100 13,659,236,701 100 3,120,164 5,839,578,803 100
Table 3: cost effectiveness analysis of two different drugs to elimination of H-P in Persian Cohort participants in north-west of Iran, Ardabil 2018-2019
Cost-Effectiveness Effect Ratio Mean Costs PoTS NeTS Total Subjects
2,988,488 85.93 2,570,100 867 5296 6163 Group A
3,250,170 96.54 3,120,164 46 1287 1333 Group B
NeTS= Negative stool test for H-Pylori, PoTS= Positive stool test for H-Pylori, Effect Ratio= NeTS or PoTS / Total Subject, Cost-Effectiveness= Mean Costs / Effect Ratio
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