TOPLINE:

Bismuth quadruple therapy was cost‑effective as a first‑line treatment for Helicobacter pylori infection, with the lowest lifetime cost per patient. Rifabutin triple therapy yielded the highest quality‑adjusted life‑years (QALYs) and — at common willingness-to-pay thresholds and over longer horizons — showed the highest net monetary benefit, emerging as a viable alternative.

METHODOLOGY:

• H pylori infection is a major public health burden in the US, contributing to peptic ulcer disease and gastric cancer. Although the 2024 American College of Gastroenterology guidelines recommend bismuth quadruple therapy as first-line treatment, its cost-effectiveness compared with other regimens remains debated.
• Researchers used a simulation model to assess the cost-effectiveness of the following five first-line regimens in treatment-naive patients with H pylori infection in the US: clarithromycin triple, vonoprazan dual, vonoprazan triple, rifabutin triple, and bismuth quadruple therapy.
• The model used a 1-year cycle and incorporated five health states: H pylori infection, H pylori eradicated, peptic ulcer disease, gastric cancer, and death.
• All five regimens were compared from a US healthcare payer perspective for expected costs, QALYs, incremental cost-effectiveness ratio per QALY gained, and net monetary benefit by using willingness-to-pay thresholds of $100,000 and $150,000 per QALY.
• Scenario analyses were conducted by varying the time horizon to 1 year, 10 years, and 20 years to assess how cost-effectiveness and net monetary benefit for the five regimens changed over different timeframes.

TAKEAWAY:

• Bismuth quadruple therapy had the lowest lifetime cost per patient ($193,651), dominated clarithromycin triple and vonoprazan dual therapies, and served as the reference strategy in the analysis.
• Rifabutin triple therapy yielded the highest QALYs (17.523) and had an incremental cost-effectiveness ratio of $45,971 per QALY gained compared with bismuth quadruple therapy.
• Vonoprazan triple therapy yielded 17.517 QALYs but was not cost-effective, with an incremental cost-effectiveness ratio of $290,572 per QALY gained vs bismuth quadruple therapy. Both clarithromycin triple and vonoprazan dual therapies yielded the lowest net monetary benefits among all.
• Over a 1-year time horizon, at a willingness-to-pay threshold of $100,000 per QALY, the net monetary benefit was highest for bismuth quadruple therapy; in 10- and 20-year analyses, at a willingness-to-pay threshold of $100,000 per QALY, rifabutin triple therapy yielded the highest net monetary benefits ($825,973 and $1,161,752, respectively).

IN PRACTICE:

“Policymakers and healthcare providers should prioritize BQT [bismuth quadruple therapy] and rifabutin triple therapy to improve patient outcomes and reduce the economic burden of H pylori-related disease,” the authors of the study wrote.

SOURCE:

The study was led by Ligang Liu, The Ohio State University, Columbus, Ohio. It was published online in the American Journal of Gastroenterology.

LIMITATIONS:

The efficacy of bismuth quadruple therapy was assessed mainly from trials conducted nearly 20 years ago. The model used fixed eradication rates and simplified disease progression pathways. The study was also limited by using clinical trial data rather than real-world effectiveness and adherence rates.

DISCLOSURES:

The study did not report any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.