Howden Colin W, Cook Erin E, Swallow Elyse, Yang Karen, Guo Helen, Pelletier Corey, Jacob Rinu, Sugano Kentaro
University of Tennessee College of Medicine, Memphis, TN 38163, USA.
Analysis Group, Inc., Boston, MA, USA.
Therap Adv Gastroenterol. 2023 May 2;16:17562848231168714. doi: 10.1177/17562848231168714. eCollection 2023.
Japanese guidelines recommend triple therapy with vonoprazan or a proton pump inhibitor (PPI) in combination with antibiotics to treat () infection. While studies have shown improved eradication rates and reduced costs with vonoprazan PPIs, there is little data describing healthcare resource use (HCRU) and treatment patterns.
To compare patients treated with a vonoprazan-based or PPI-based regimen for infection in Japan in terms of their characteristics, HCRU, healthcare costs, clinical outcomes, and treatment patterns.
Retrospective matched cohort.
We used data from the Japan Medical Data Center claims database (July 2014-January 2020) to identify adult patients with infection and a first observed use of vonoprazan or a PPI in 2015 or later (index date). Patients prescribed a vonoprazan-based or a PPI-based regimen were matched 1:1 using propensity score matching. HCRU, healthcare costs, diagnostic tests, a proxy for eradication (i.e. no triple therapy with amoxicillin in combination with metronidazole or clarithromycin >30 days after the index date), and second-line treatment were described during the 12-month follow-up period.
Among 25,389 matched pairs, vonoprazan-treated patients had fewer all-cause and related inpatient stays and outpatient visits than PPI-treated patients, resulting in lower all-cause healthcare costs [185,378 Japanese yen (JPY) 230,876 JPY, < 0.001]. Over 80% of patients received a post-treatment test for . Fewer vonoprazan-treated than PPI-treated patients subsequently received an additional triple regimen for infection (7.1% 20.0%, < 0.001) or a prescription for vonoprazan or a PPI as monotherapy (12.4% 26.4%, < 0.001) between 31 days and 12 months after the index date.
Patients with infection who were treated with vonoprazan-based therapy had lower rates of subsequent treatment, lower overall and -related HCRU, and lower healthcare costs than patients treated with PPI-based therapy.
日本指南推荐使用沃克奥美拉唑或质子泵抑制剂（PPI）联合抗生素进行三联疗法来治疗（）感染。虽然研究表明，与PPI相比，使用沃克奥美拉唑可提高根除率并降低成本，但关于医疗资源使用（HCRU）和治疗模式的数据较少。
比较在日本接受基于沃克奥美拉唑或基于PPI方案治疗（）感染的患者在特征、HCRU、医疗成本、临床结局和治疗模式方面的差异。
回顾性匹配队列研究。
我们使用了日本医疗数据中心索赔数据库（2014年7月至2020年1月）的数据，以识别2015年或之后首次使用沃克奥美拉唑或PPI的感染成年患者（索引日期）。使用倾向得分匹配法将接受基于沃克奥美拉唑或基于PPI方案治疗的患者进行1:1匹配。在12个月的随访期内描述了HCRU、医疗成本、诊断测试、根除的替代指标（即索引日期后30天以上未使用阿莫西林联合甲硝唑或克拉霉素进行三联疗法）以及二线治疗情况。
在25389对匹配患者中，接受沃克奥美拉唑治疗的患者全因住院和相关住院天数以及门诊就诊次数均少于接受PPI治疗的患者，导致全因医疗成本更低[185378日元（JPY）对230876日元，P＜0.001]。超过80%的患者接受了治疗后的检测。在索引日期后31天至12个月之间，接受沃克奥美拉唑治疗的患者中随后接受额外三联疗法治疗（）感染的比例低于接受PPI治疗的患者（7.1%对20.0%，P＜0.001），接受沃克奥美拉唑或PPI单药治疗的比例也更低（12.4%对26.4%，P＜0.001）。
与接受基于PPI治疗的患者相比，接受基于沃克奥美拉唑治疗的（）感染患者后续治疗率更低，总体和与（）相关的HCRU更低，医疗成本也更低。
