Cost-Effectiveness of Tailored vs. Empirical Therapy for H. pylori: A Decision-Tree Analysis

Background: In Korea, tailored therapy for H. pylori based on clarithromycin resistance has been shown to be more effective than empirical therapy. However, the cost-effectiveness of tailored therapy has not yet been fully established. Aim: This study evaluated the cost-effectiveness of tailored therapy guided by genotypic resistance compared to empirical clarithromycin-based triple therapy. Methods: A decision-tree model was developed to compare two treatment strategies: empirical therapy and tailored therapy. In the empirical therapy group, patients received clarithromycin-based triple therapy. In the tailored therapy group, patients susceptible to clarithromycin received clarithromycin-based triple therapy, while those with clarithromycin resistance were treated with bismuth-based quadruple therapy. A cost-effectiveness analysis was conducted, and the incremental cost-effectiveness ratio (ICER) was calculated to compare the two strategies. Results: The estimated costs for empirical and tailored therapies were $173.93 and $249.48, respectively. Compared to empirical therapy, the ICER for tailored therapy was $4.66 per 1% increase in eradication rate, representing the additional cost required to achieve a 1% improvement in eradication. In subgroup analyses, the estimated costs of 7-day empirical and tailored therapies were $157.46 and $233.88, respectively, while the costs for 14-day empirical and tailored therapies were $190.40 and $265.08, respectively. The ICERs for the 7- and 14-day regimens were $3.53 and $7.12, respectively. Discussion: Tailored therapy guided by genotypic resistance is a cost-effective strategy for H. pylori eradication in Korea, particularly in the context of high clarithromycin resistance rates.