Cost-effectiveness analysis of two routine therapeutic methods for 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
Aim: This study aimed to analyze the cost-effectiveness of two routine therapeutic methods for H. pylori eradication in Iran
Background: Because of the importance of Helicobacter pylori (H. pylori) eradication on gastric cancer prevalence and costs, an economic analysis of the eradication methods is essential for health systems.
Methods: This cross-sectional study was conducted on 7,496 participants with positive Hepadnaviridae (HPsAg) test results for H. pylori; 6,163 of them were treated with furazolidone (group A), and 1,333 participants were treated with clarithromycin (group B). Data on GP visits, medications, and HPsAg costs as direct costs and absence from work and transportation as indirect costs was collected by researcher-made questionnaire. Indirect costs were calculated based on face-to-face interviews with 365 patients of the Persian Cohort Center. Successful eradication of H. pylori infection (negative HPsAg) was defined as the effectiveness of the interventions. Incremental cost-effectiveness ratio (ICER) was 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 was higher for clarithromycin (CE=3,250,170 IRR) than for furazolidone (CE=2,988,488 IRR), and ICER showed that 5.1 Million IRR per participant is needed to eradicate H. pylori.
Conclusion: Based on the results, furazolidone was more cost-effective 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 considering the results of further research and possible side effects.
Keywords: Cost-effectiveness, Helicobacter pylori, Eradication, Furazolidone, Clarithromycin.
(Please cite as: Pourfarzi F, Zahirian Moghadam T, Zandian H, Malekzadeh R, Yazdanbod A. Cost-effectiveness analysis of two routine therapeutic methods for Helicobacter pylori eradication: a Persian cohort-based study. Gastroenterol Hepatol Bed Bench 2021;14(3):250-259).
- Cost-Effectiveness, Helicobacter Pylori, Eradication, Furazolidone, Clarithromycin
Uemura N, Okamoto S, Yamamoto S, Matsumura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001;345:784-9.
Zhang RG, Duan GC, Fan QT, Chen SY. Role of Helicobacter pylori infection in pathogenesis of gastric carcinoma. World J Gastrointest Pathophysiol 2016;7:97.
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. Ann Rheum Dis 2017;76.
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. Iran J Pathol 2018;13:38.
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;153:420-9.
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;9:252-63.
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. Aliment Pharmacol Ther 2018;47:868-76.
Tareen A, Butt T, Ali B. Helicobacter pylori infection in patients with chronic urticaria and dyspepsia, experience from a developing country. J Pakistan Assoc Dermatologists 2017;26:206-13.
Moosazadeh M, Lankarani KB, Afshari M. Meta-analysis of the prevalence of Helicobacter pylori infection among children and adults of Iran. Int J Prev Med 2016;7.
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. Lancet 2016;387:2145-54.
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. Int J Hum Rights Healthc 2018.
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. J Prev Med Public Health 2018;51:83.
Mahdavi M, Parsaeian M, Jaafaripooyan E, Ghaffari S. Recent Iranian health system reform: an operational perspective to improve health services quality. Int J Health Policy Manag 2018;7:70.
Veisani Y, Delpisheh A. Survival rate of gastric cancer in Iran; a systematic review and meta-analysis. Gastroenterol Hepatol Bed Bench 2016;9:78.
Abdi E, Latifi-Navid S, Yazdanbod A, Zahri S. Helicobacter pylori babA2 positivity predicts risk of gastric cancer in Ardabil, a very high-risk area in Iran. Asian Pac J Cancer Prev 2016;17:733-8.
Leylabadlo HE, Kafil HS, Yousefi M. Gastric cancer mortality in a high-incidence area (Ardabil Province, Northwest Iran): What risk factors are causative? Eur J Cancer Prev 2016;25.
Malekzadeh R, Derakhshan MH, Malekzadeh Z. Gastric cancer in Iran: epidemiology and risk Factors. Arch Iran Med 2009;12:576-83.
Boreiri M, Samadi F, Etemadi A, Babaei M, Ahmadi E, Sharifi AH, et al. Gastric cancer mortality in a high incidence area: long-term follow-up of Helicobacter pylori-related precancerous lesions in the general population. Arch Iran Med 2013;16:343.
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. Med J Islam Repub Iran 2016;30:327.
Almasi Z, Rafiemanesh H, Salehiniya H. Epidemiology characteristics and trends of incidence and morphology of stomach cancer in Iran. Asian Pac J Cancer Prev 2015;16:2757-61.
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. Dig Dis Sci 2019:1-10.
Omata F, Shimbo T, Ohde S, Deshpande GA, Fukui T. Cost-Effectiveness Analysis of Helicobacter pylori Diagnostic Methods in Patients with Atrophic Gastritis. Gastroenterol Res Pract 2017;2017.
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. Int J Clin Pract 2019;73:e13349.
Suzuki H, Matsuzaki J. Helicobacter pylori eradication failure may have confounded the recent large-scale health database study that showed proton pump inhibitors increase gastric cancer risk. Gut 2018;67:2071.
Altintas E, Sezgin O, Ulu O, Aydin O, Camdeviren H. Maastricht II treatment scheme and efficacy of different proton pump inhibitors in eradicating Helicobacter pylori. World J Gastroenterol 2004;10:1656.
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;56:772-81.
Kajihara Y, Shimoyama T, Mizuki I. Analysis of the cost-effectiveness of using vonoprazan–amoxicillin–clarithromycin triple therapy for first-line Helicobacter pylori eradication. Scand J Gastroenterol 2017;52:238-41.
Hajaghamohammadi A, Tali SHS, Samimi R, Oveisi S, Kazemifar AM. Low Dose Furazolidone for Eradication of Helicobacter pylori Instead of Clarithromycin: A Clinical Trial. Glob J Health Sci 2015;7:235.
Yi DM, Yang TT, Chao SH, Li YX, Zhou YL, Zhang HH, et al. Comparison the cost-efficacy of furazolidone-based versus clarithromycin-based quadruple therapy in initial treatment of Helicobacter pylori infection in a variable clarithromycin drug-resistant region, a single-center, prospective, randomized, open-label study. Medicine 2019;98:e14408-e.
Mohammadi M, Attaran B, Malekzadeh R, Graham DY. Furazolidone, an underutilized drug for H. pylori eradication: lessons from Iran. Dig Dis Sci 2017;62:1890-6.
Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ 2001;20:461-94.
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 J Gastroenterol 2014;20:17618.
Soltani J, Amirzadeh J, Nahedi S, Shahsavari S. Prevalence of helicobacter pylori infection in children, a population-based cross-sectional study in west iran. Iran J Pediatr 2013;23:13.
Thomson Reuters. Physicians’ Desk Reference 2009 [Available from: https://www.amazon.com/Physicians-Desk-Reference-Electronic-Library/dp/1563637251.
Khademi F, Poursina F, Hosseini E, Akbari M, Safaei HG. Helicobacter pylori in Iran: A systematic review on the antibiotic resistance. Iran J Basic Med Sci 2015;18:2.
Treiber G. The influence of drug dosage on Helicobacter pylori eradication: a cost-effectiveness analysis. Am J Gastroenterol 1996;91.
Fatahi E. Comparison of Helicobacter pylori eradication with four drug regimens in dyspeptic patients. Journal of Yazd University of Medical Sciences. Journal of Yazd Uni Med Sci 2016;2:1-12.
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;4:128-34.
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. Am J Gastroenterol 2003;98:2149-56.
Riahizadeh S, Malekzadeh R, Agah S, Zendehdel N, Sotoudehmanesh R, Ebrahimi-Dariani N, et al. Sequential Metronidazole-Furazolidone or Clarithromycin-Furazolidone Compared to Clarithromycin-Based Quadruple Regimens for the Eradication of Helicobacter pylori in Peptic Ulcer Disease: A Double-Blind Randomized Controlled Trial. Helicobacter 2010;15:497-504.
Aminian K, Ghanbari A, Joukar F, Farsad F, Shahrokhi Rad R, Mansour Ghanaei F. Comparison of three-drug, four-drug and two different Sequential regimens in the treatment of first-line Helicobacter pylori infection. Iranian Journal of Infectious Diseases and Tropical Medicine 2010;15:7-11.
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 Pac J Trop Dis 2012;2:S783-9.
Miura S, Hokari R. Seeking an optimal eradication therapy for Helicobacter pylori infection. J Gastroenterol Hepatol 2012;27:7-9.
Nash C, Fischbach L, van Zanten SV. What are the global response rates to Helicobacter pylori eradication therapy? Can J Gastroenterol Hepatol 2003;17:25B-9.
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;312:1321-5.
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. Aliment Pharmacol Ther 2001;15:1777-85.
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. Int J Clin Pharmacol Ther 2006;44.
Fischbach L, Van Zanten S, Dickason J. Meta‐analysis: the efficacy, adverse events, and adherence related to first-line anti-Helicobacter pylori quadruple therapies. Aliment Pharmacol Ther 2004;20:1071-82.
- Abstract Viewed: 0 times
- PDF Downloaded: 0 times