Economic Evaluation of Empirical and Tailored Helicobacter pylori Eradication Strategies Including Second-Line Therapy

Objectives: To our knowledge, no study has evaluated the cost-effectiveness of tailored therapy guided by genotypic resistance compared with empirical clarithromycin-based triple therapy, including second-line therapies. Methods: A decision tree model was developed to compare empirical and tailored treatment strategies. Cost-minimization and cost-effectiveness analyses were conducted. The incremental cost-effectiveness ratio (ICER) was calculated to compare the two strategies, including second-line therapy.Results: The empirical therapy incurred a lower cost per patient (USD 211.49) than the tailored therapy (USD 269.88). The overall eradication rates were nearly identical (97.98% vs. 98.05%), yielding an ICER of USD 859.00 per 1% gain in eradication. Empirical therapy consistently resulted in lower total costs for all treatment durations. In the 7-day regimen, empirical therapy (USD 201.52; 97.64% eradication) versus tailored therapy (USD 253.62; 98.12%) produced an ICER of USD 108.54 per 1%, in favor of the empirical approach. In the 14‑day regimen, tailored therapy was more expensive (USD 282.74 vs. USD 221.46) and slightly less effective (97.97%, 98.34%). Overall, empirical therapy is a cost-effective strategy in most cases.Conclusions: This study demonstrates that tailored therapy guided by genotypic resistance is no more cost-effective than empirical therapy when second-line therapy is included. Future studies are warranted to identify strategies to improve the cost-effectiveness of tailored therapies in clinical practice.