Digestive Disease Center, Soonchunhyang University Hospital, Seoul, Korea.
Department of Pathology, Soonchunhyang University Hospital, Seoul, Korea.
J Gastroenterol Hepatol. 2019 Apr;34(4):700-706. doi: 10.1111/jgh.14383. Epub 2018 Aug 2.
The Helicobacter pylori eradication rate using conventional triple therapy has decreased due to clarithromycin (CAM) resistance in H. pylori. Recently, dual priming oligonucleotide (DPO)-based multiplex polymerase chain reaction (PCR) can be used to detect H. pylori and point mutations in the 23S ribosomal RNA gene causing CAM resistance. This study aimed to evaluate the success rate and cost-effectiveness of tailored H. pylori eradication using DPO-PCR.
The H. pylori-positive patients diagnosed by a rapid urease test or DPO-PCR were enrolled from a single academic hospital. The patients with positive rapid urease test results received a CAM-based triple regimen. In the tailored therapy group that underwent DPO-PCR testing, patients with A2142G and/or A2143G point mutations were treated with a bismuth-containing quadruple regimen. The cost-effectiveness of H. pylori eradication success was evaluated according to the average cost per patient and the incremental cost-effectiveness ratio.
A total of 243 patients were allocated to the triple therapy group and 124 patients to the tailored therapy group. The first-line eradication rate of H. pylori was significantly higher in the tailored therapy group than in the conventional triple therapy group (92.7% vs 76.5%, P < 0.001). The average costs per patient for tailored therapy were $307.37 and $299.59 for first-line and second-line treatments, respectively. Compared with triple therapy, the incremental cost-effectiveness ratios of tailored therapy were $3.96 and -$3.81 per patient for first-line and second-line treatments, respectively.
In Korea, tailored H. pylori eradication using DPO-PCR may be more cost-effective than conventional triple therapy.
由于幽门螺杆菌（H. pylori）对克拉霉素（CAM）的耐药性，传统三联疗法的 H. pylori 根除率有所下降。最近，基于双重引物寡核苷酸（DPO）的多重聚合酶链反应（PCR）可用于检测 H. pylori 以及导致 CAM 耐药的 23S 核糖体 RNA 基因中的点突变。本研究旨在评估基于 DPO-PCR 的靶向 H. pylori 根除的成功率和成本效益。
从一家学术医院招募经快速尿素酶试验或 DPO-PCR 诊断为 H. pylori 阳性的患者。对快速尿素酶试验结果阳性的患者给予 CAM 三联方案。在接受 DPO-PCR 检测的靶向治疗组中，对存在 A2142G 和/或 A2143G 点突变的患者给予含铋的四联方案治疗。根据每位患者的平均成本和增量成本效益比评估 H. pylori 根除成功的成本效益。
共有 243 名患者被分配至三联治疗组，124 名患者被分配至靶向治疗组。靶向治疗组的 H. pylori 一线根除率显著高于传统三联疗法组（92.7% vs. 76.5%，P<0.001）。靶向治疗的每位患者的平均成本分别为一线和二线治疗的 307.37 美元和 299.59 美元。与三联疗法相比，靶向治疗的增量成本效益比分别为一线和二线治疗的 3.96 美元和-3.81 美元。
在韩国，基于 DPO-PCR 的靶向 H. pylori 根除可能比传统三联疗法更具成本效益。
