Cost-Effectiveness of Various First-Line Helicobacter pylori Eradication Regimens in Korea: Analysis of the Korean Registry on the Current Management of H. pylori (K-Hp-Reg).

BACKGROUND/AIMS: Current Korean guidelines recommend five different strategies for first-line eradication. No study has compared the cost-effectiveness of these five strategies in Korea. METHODS: A decision tree model was developed to assess the costs and eradication outcomes of the five first-line eradication strategies. Empirical regimens included 14-day clarithromycin-based triple therapy (CTT), 10-day sequential therapy (ST), 10-day concomitant therapy (CT), and bismuth quadruple therapy (BQT). Tailored therapy (TT) was defined as resistance-guided treatment, in which patients with clarithromycin-resistant infections received 7-day BQT and those without resistance received 7-day CTT. Eradication rates were derived from the Korean nationwide Helicobacter pylori registry. RESULTS: Among the empirical regimens, 14-day CTT showed the lowest eradication rate and highest cost. In contrast, ST, CT, and BQT demonstrated lower costs and higher eradication rates than 14-day CTT. TT achieved an overall eradication rate of 88.9% at a total cost of USD 221.91, which was higher than that of any empirical regimen. Compared with BQT, TT was associated with higher costs and lower eradication rates. Compared with ST, CT, and CTT, TT incurred higher costs but achieved higher eradication rates, with incremental cost-effectiveness ratios ranging from USD 3.82 to USD 21.34 per 1% increase in eradication rate. CONCLUSIONS: BQT demonstrated the most favorable cost-effectiveness among the first-line regimens recommended by the Korean guidelines. Although TT proved to be more cost-effective than CTT, it did not demonstrate superior cost-effectiveness compared with BQT.