Cost-effectiveness Analysis Comparing Vonoprazanbased Triple Therapy with Proton Pump Inhibitorbased Therapy in the Treatment of Helicobacter pylori Infection in Thailand
DOI:
https://doi.org/10.33192/Smj.2021.107Keywords:
Cost-effectiveness, Vonoprazen, Proton pump inhibitors, Levofloxacin, Concomitant, Helicobacter pylori infectionAbstract
Objective: Helicobacter pylori (H. pylori) infection is one of the leading causes of gastrointestinal diseases such as dyspepsia, peptic ulcers. Thailand has a 45.9% prevalence of the infection and an increasing rate of resistance to clarithromycin, leading to standard treatments being less successful. Vonoprazan represents a novel drug offering a new treatment regimen. Although vonoprazan has been available in Thailand since 2019, its cost-effectiveness has not been studied previously.
Materials and Methods: This study analysed the cost-effectiveness of vonoprazan-based triple therapy compared with PPI-based therapy, in treating clarithromycin resistant H. pylori, by using the markov model from a societal perspective.
Results: The total cost of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 784,932.08 baht, 783,863.65 baht and 783,874.55 baht respectively. The quality-adjusted life years (QALYs) of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 25.1118 years, 25.1147 years and 25.1054 years respectively. The cost-effectiveness ratio (CER) of vonoprazanbased triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 31,257.50 baht/ QALYs, 31,211.35 baht/QALYs and 31,223.34 baht per QALYs respectively.
Conclusion: Therefore, levofloxacin-PPI based triple therapy was found to be the most cost-effective regimen and the dominant strategy compared with concomitant-PPI or vonoprazan-based triple therapy. It provided higher QALYs and lower treatment costs. Levofloxacin-PPI based triple therapy should be the first choice of an alternative strategy in treating clarithromycin-resistant H. pylori. The results of this study can be used by policymakers to help inform their decisions.
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33. Tamaki H, Noda T, Morita M, Omura A, Kubo A, Ogawa C, et al. An Open-Label, Multi-Center, Randomized, Superiority Trial of Vonoprazan Versus Esomeprazole as Part of First-Line Triple Therapy for Helicobacter Pylori Infection. Gastroenterology. 2019;156(6):S-89.
34. Ang TL, Fock KM, Song M, Ang D, Kwek AB, Ong J, et al. Ten-day triple therapy versus sequential therapy versus concomitant therapy as first-line treatment for Helicobacter pylori infection. J Gastroenterol Hepatol. 2015;30(7):1134-9.
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43. Grunberg SM, Magnan WF, Herndon J, Naughton ML, Blackwell KL, Wood ME, et al. Determination of utility scores for control of chemotherapy-induced nausea or vomiting. J Support Oncol. 2009;7:W17-W22.
44. Shlomai A, Leshno M, Goldstein DA. Regorafenib treatment for patients with hepatocellular carcinoma who progressed on Lertsirimunkong et al.
https://he02.tci-thaijo.org/index.php/sirirajmedj/index Volume 73, No.12: 2021 Siriraj Medical Journal 823 Original Article SMJ
sorafenib-A cost-effectiveness analysis. Plos One. 2018;13(11):e0207132.
45. Sher DJ, Tishler RB, Pham NL, Punglia RS. Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus Proton Therapy for Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2018;101(4):875-82.
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49. Chuensuwan R. The Novel Drug for Acid Related Diseases. J Prapokklao Hosp Clin Med Educat Center. 2020;37(4):364-72.
2. Phukpo W. The diagnostic test of bloodstream infection for Helicobacter pylori. Tham-Lab. 2018;5(3):3-8.
3. The Gastroenterological Association of Thailand. Thailand Consensus on Helicobacter Pylori Management 2015. Bangkok: Concept Medicus Co.,Ltd; 2015. 1-35 p.
4. Jaka H, Mueller A, Kasang C, Mshana SE. Predictors of triple therapy treatment failure among H. pylori infected patients attending at a tertiary hospital in Northwest Tanzania: a prospective study. BMC Infect Dis. 2019;19(1):447.
5. Vilaichone RK, Quach DT, Yamaoka Y, Sugano K, Mahachai V. Prevalence and Pattern of Antibiotic Resistant Strains of Helicobacter Pylori Infection in ASEAN. Asian Pac J Cancer P. 2018;19(5):1411-3.
6. Malfertheiner P, Megraud F, O’Morain CA, Gisbert JP, Kuipers EJ, Axon AT, et al. Management of Helicobacter pylori infectionthe Maastricht V/Florence Consensus Report. Gut. 2017;66(1): 6-30.
7. Mahachai V, Vilaichone RK, Pittayanon R, Rojborwonwitaya J, Leelakusolvong S, Maneerattanaporn M, et al. Helicobacterpylori management in ASEAN: The Bangkok consensus report. J Gastroenterol Hepatol. 2018;33(1):37-56.
8. Sachs G, Scott DR, Wen Y. Gastric infection by Helicobacter pylori. Curr Gastroenterol Rep. 2011;13(6):540-6.
9. Tantiwit J. Vonoprazan: The new acid blocker. Center for Continuing Pharmaceutical Education. 2020:1-23.
10. Akazawa Y, Fukuda D, Fukuda Y. Vonoprazan-based therapy for Helicobacter pylori eradication: experience and clinical evidence. Ther Adv Gastroenter. 2016;9(6):845-52.
11. Li M, Oshima T, Horikawa T, Tozawa K, Tomita T, Fukui H, et al. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacterpylori. Helicobacter. 2018;23(4):e12495.
12. The Subcommittee of National List of Essential Medicines Development. The Manual of Health Technology Assessment in Thailand. Nonthaburi: The Graphico Systems Co., Ltd.; 2009.
13. Suzuki S, Gotoda T, Kusano C, Iwatsuka K, Moriyama M. The Efficacy and Tolerability of a Triple Therapy Containing a Potassium-Competitive Acid Blocker Compared With a 7-Day PPI-Based Low-Dose Clarithromycin Triple Therapy. Am J Gastroenterol. 2016;111(7):949-56. 822 Volume 73, No.12: 2021 Siriraj Medical Journal https://he02.tci-thaijo.org/index.php/sirirajmedj/index
14. Sanglutong L, Aumpan N, Pornthisarn B, Chonprasertsuk S, Siramolpiwat S, Bhanthumkomol P, et al. Ineffectiveness of 14-Day Vonoprazan-Based Dual Therapy and Vonoprazan-Based Triple Therapy for Helicobacter Pylori Eradication in Area of High Clarithromycin Resistance: A Prospective Randomized Study. Gastroenterology. 2020;158(6):S-571.
15. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, doubleblind study. Gut. 2016;65(9):1439-46.
16. Kim SY, Chung J-W. Best Helicobacter pylori Eradication Strategy in the Era of Antibiotic Resistance. Antibiotics. 2020; 9(8):436.
17. Maruyama M, Tanaka N, Kubota D, Miyajima M, Kimura T, Tokutake K, et al. Vonoprazan-Based Regimen Is More Useful than PPI-Based One as a First-Line Helicobacter pylori Eradication: A Randomized Controlled Trial. Can J Gastroenterol Hepatol. 2017;2017:4385161-.
18. Tai W-C, Lee C-H, Chiou S-S, Kuo C-M, Kuo C-H, Liang C-M, et al. The Clinical and Bacteriological Factors for Optimal
Levofloxacin-Containing Triple Therapy in Second-Line Helicobacter pylori Eradication. Plos One. 2014;9(8):e105822.
19. Chung JW, Han JP, Kim KO, Kim SY, Hong SJ, Kim TH, et al. Ten-day empirical sequential or concomitant therapy is more effective than triple therapy for Helicobacter pylori eradication: A multicenter, prospective study. Dig Liver Dis. 2016;48(8):888-92.
20. Kim BJ, Lee H, Lee YC, Jeon SW, Kim GH, Kim H-S, et al. Ten-Day Concomitant, 10-Day Sequential, and 7-Day Triple Therapy as First-Line Treatment for Helicobacter pylori Infection: A Nationwide Randomized Trial in Korea. Gut Liver. 2019;13(5):531-40.
21. Park SM, Kim JS, Kim BW, Ji JS, Choi H. Randomized clinical trial comparing 10- or 14-day sequential therapy and 10- or 14-day concomitant therapy for the first line empirical treatment of Helicobacter pylori infection. J Gastroenterol Hepatol. 2017;32(3):589-94.
22. Kim SY, Lee SW, Choe JW, Jung SW, Hyun JJ, Jung YK, et al. Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea. Helicobacter. 2017;22(6).
23. Liou JM, Fang YJ, Chen CC, Bair MJ, Chang CY, Lee YC, et al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2016;388(10058):2355-65.
24. Heo J, Jeon SW, Jung JT, Kwon JG, Lee DW, Kim HS, et al. Concomitant and hybrid therapy for Helicobacter pylori infection: A randomized clinical trial. J Gastroenterol Hepatol. 2015;30(9):1361-6.
25. Heo J, Jeon SW, Jung JT, Kwon JG, Kim EY, Lee DW, et al. A randomised clinical trial of 10-day concomitant therapy and standard triple therapy for Helicobacter pylori eradication. Dig Liver Dis. 2014;46(11):980-4.
26. Kim SJ, Chung J-W, Woo HS, Kim SY, Kim JH, Kim YJ, et al. Two-week bismuth-containing quadruple therapy and concomitant therapy are effective first-line treatments for Helicobacter pylori eradication: A prospective open-label randomized trial. World J Gastroenterol. 2019;25(46):6790-8.
27. Peura DA, LaMon JT, Moynihan LK, Bonis PAL. Helicobacter Pylori: Bay Area Houston Gastroenterology Associates; [cited 2020 6 Jun]. Available from: http://www.bayareahoustongastro.com/wp-content/uploads/Helicobacter-Pylori.pdf.
28. Health Information System Development Office. Trend of health in Thailand 2017 [cited 2020 6 Nov]. Available from: https://www.hiso.or.th/health/data/html/search1.php?menu=1&i=.
29. Chen Y, Segers S, Blaser MJ. Association between Helicobacter pylori and mortality in the NHANES III study. Gut. 2013;62(9):1262-9.
30. Apostolopoulos P, Koumoutsos I, Ekmektzoglou K, Dogantzis P, Vlachou E, Kalantzis C, et al. Concomitant versus sequential therapy for the treatment of Helicobacter pylori infection: a Greek randomized prospective study. Scand J Gastroentero. 2016;51(2):145-51.
31. Burden of Disease Thailand. Health Adjusted Life Expectancy: HALE. Burden of Disease Research Program Thailand; 2018.
32. Vilaichone RK, Wongcha Um A, Chotivitayatarakorn P. Low Re-infection Rate of Helicobacter pylori after Successful Eradication in Thailand: A 2 Years Study. Asian Pac J Cancer P. 2017;18(3):695-7.
33. Tamaki H, Noda T, Morita M, Omura A, Kubo A, Ogawa C, et al. An Open-Label, Multi-Center, Randomized, Superiority Trial of Vonoprazan Versus Esomeprazole as Part of First-Line Triple Therapy for Helicobacter Pylori Infection. Gastroenterology. 2019;156(6):S-89.
34. Ang TL, Fock KM, Song M, Ang D, Kwek AB, Ong J, et al. Ten-day triple therapy versus sequential therapy versus concomitant therapy as first-line treatment for Helicobacter pylori infection. J Gastroenterol Hepatol. 2015;30(7):1134-9.
35. The drug’s median price in Thailand [Internet]. National Drug Information. 2020 [cited 20 Apr 2020]. Available from: http://ndi.fda.moph.go.th/drug_value.
36. Drugs price list [Internet]. Department of Internal Trade, Ministry of Commerce. 2020 [cited 9 Dec 2020]. Available from: https://hospitals.dit.go.th/app/drug_price_list.php.
37. Specific screening program (H. pylori) [Internet]. Yanhee Hospital. 2020 [cited 6 Nov 2020]. Available from: https://th.yanhee.net/.
38. Urea Breath Test [Internet]. Bumrungrad International Hospital. 2020 [cited 6 Nov 2020]. Available from: https://www.bumrungrad.
com/en/treatments/urea-breath-test. 39. Urea Breath Test [Internet]. Vichaivej Nongkhaem International Hospital. [cited 6 Nov 2020]. Available from: https://vichaivejnongkhaem.com/packages/ตรวจหาเชื้อ-h-pylori-ด้วยวิธีเป/.
40. Ministry of Public Health, Thailand. The service charge of public health services affiliated with the Ministry of Public Health, Thailand. In: Ministry of Public Health, Thailand, editors.: Ministry of Public Health, Thailand; 2019. p. 4-88.
41. Standard Cost Lists for Health Technology Assessment [Internet]. The Ministry of Public Health, Thailand. 2020 [cited 6 Nov 2020]. Available from: https://costingmenu.hitap.net/.
42. Xie F, Luo N, Lee H-P. Cost effectiveness analysis of populationbased serology screening and (13)C-Urea breath test for Helicobacter pylori to prevent gastric cancer: a markov model. World J Gastroentero. 2008;14(19):3021-7.
43. Grunberg SM, Magnan WF, Herndon J, Naughton ML, Blackwell KL, Wood ME, et al. Determination of utility scores for control of chemotherapy-induced nausea or vomiting. J Support Oncol. 2009;7:W17-W22.
44. Shlomai A, Leshno M, Goldstein DA. Regorafenib treatment for patients with hepatocellular carcinoma who progressed on Lertsirimunkong et al.
https://he02.tci-thaijo.org/index.php/sirirajmedj/index Volume 73, No.12: 2021 Siriraj Medical Journal 823 Original Article SMJ
sorafenib-A cost-effectiveness analysis. Plos One. 2018;13(11):e0207132.
45. Sher DJ, Tishler RB, Pham NL, Punglia RS. Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus Proton Therapy for Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys. 2018;101(4):875-82.
46. Consumer Price Index [Internet]. 2021 [cited 15 February 2021]. Available from: http://www.price.moc.go.th/price/cpi/index_new.asp.
47. Yamasaki T, Owari M, Tokai Y, Amano Y, Nakashima H, Sakaki N, et al. High Dose CAM With Vonoprazan (P-CAB) PLUS AMX Regimen Is the Strongest H. pylori Eradication Triple Therapy Regimens to Improve Success Rate of CAM Based Regimens. Gastroenterology. 2016;150(4, Supplement 1):S879.
48. Areesinpitak T, Kanjanawart S, Nakkam N, Tassaneeyakul W, Vannaphasaht S. Prevalence of CYP2C19, CYP3A4 and FMO3 genetic polymorphisms in healthy northeastern Thai volunteers. Scienceasia. 2020;46(3):397-402.
49. Chuensuwan R. The Novel Drug for Acid Related Diseases. J Prapokklao Hosp Clin Med Educat Center. 2020;37(4):364-72.
Published
01-12-2021
How to Cite
Lertsirimunkong, J. ., Thavornwattanayong, W. ., Napuk, Y. ., Ajcharoen, W. ., Chaisitsanguan, V. ., & Wachiranukornkul, S. (2021). Cost-effectiveness Analysis Comparing Vonoprazanbased Triple Therapy with Proton Pump Inhibitorbased Therapy in the Treatment of Helicobacter pylori Infection in Thailand. Siriraj Medical Journal, 73(12), 823–831. https://doi.org/10.33192/Smj.2021.107
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