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

ABSTRACT 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.