High Potency Proton Pump Inhibitor Versus Vonoprazan in Helicobacter pylori Triple Therapy

Area of Science:

• Pharmacoeconomics
• Gastroenterology
• Infectious Diseases

Background:

• The high cost of newly introduced drugs like vonoprazan presents a challenge in the United States.
• Cost-effectiveness of vonoprazan clarithromycin triple therapy for H. pylori was evaluated.
• Comparison focused on cure rates and costs to achieve ≥90% cure with vonoprazan versus proton pump inhibitor (PPI) triple therapy.

Purpose of the Study:

• To determine the cost-effectiveness of vonoprazan versus esomeprazole clarithromycin triple therapy for H. pylori eradication.
• To compare cure rates and total treatment costs between vonoprazan and PPI-based therapies.
• To identify the most cost-effective strategy considering varying resistance patterns and salvage therapies.

Main Methods:

• A theoretical population was simulated to compare four treatment scenarios.
• Scenarios included empiric and susceptibility-based vonoprazan or esomeprazole clarithromycin triple therapy, with and without bismuth quadruple therapy for failures.
• Drug costs reflected U.S. 2025 retail prices, with an estimated 30% clarithromycin resistance.

Main Results:

• Susceptibility-based therapy achieved the highest cure rate (92%) with 30% resistance.
• Empiric vonoprazan showed a higher cure rate (88%) than esomeprazole (77%) but increased costs 2.4-5.2 times.
• Vonoprazan therapy cost approximately $1,000,000 per 1000 patients versus $50,000 for esomeprazole.

Conclusions:

• Vonoprazan's advantage over PPIs in clarithromycin triple therapy is limited to cases with clarithromycin resistance.
• Vonoprazan therapies are 2-5 times more expensive than high-potency PPIs with minimal gains in cure rates.
• High-potency PPI triple therapy is preferred for susceptible infections; vonoprazan should be reserved for refractory cases.