Cost-effectiveness analysis of two routine therapeutic methods for Helicobacter pylori eradication: a Persian cohort-based study


Abstract

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: Clarithromycin; Cost-effectiveness; Eradication; Furazolidone; Helicobacter pylori.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
costs units for H-P elimination by two different methods A: patients treated with Amoxicillin 500 + Omeprazole 20 + Bismuth 120 + Furazolidone 100, and B: patients treated with Amoxicillin 500 + Omeprazole 20 + Bismuth 120 + Clarithromycin 500. There was no significant differences between two groups in terms of General Practitioner visit (GP), Laboratory costs (Labrat.cost), and Indirect Costs (included transportation and time costs). Nevertheless, there was a significant difference (*) between the two groups in drug costs (p<0.001), so that drug costs for group B was significantly higher than group A
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