The use of real-world evidence to generate cost analysis of antibiotic susceptibility testing (AST) in patients with Helicobacter pylori treatment failure in Thailand: A large population-based study
Abstract
Background H. pylori eradication is effective for gastric cancer prevention. Treatment failure is caused by increased antibiotic resistance. This study aimed to determine eradication rates and perform cost analysis between susceptibility-guided therapy and empirical treatment in patients with H. pylori treatment failure. Methods This retrospective cohort study included patients with dyspepsia undergoing gastroscopy at tertiary care center in Thailand from March 2014 to October 2021. Treatment failure was defined as persistent H. pylori infection after ≥1 regimen completion. Early AST was defined as AST performed shortly after first-line treatment failure. Demographic data, AST results, eradication regimens, and medication costs were collected from database and reviewed. Results Of 1080 patients with H. pylori infection, 315 had treatment failure (mean age 58.4 years; 44.4 % males). AST of 85 strains demonstrated resistance to levofloxacin (57.6 %), metronidazole (51.8 %), clarithromycin (44.7 %), and amoxicillin (4.7 %). In multivariate analysis, sequential therapy was significantly associated with treatment failure (OR 1.66; 95%CI 1.01–2.74, p = 0.045), whereas vonoprazan-containing therapy was related to treatment success (OR 1.60; 95%CI 1.04–2.48, p = 0.034). Medication nonadherence (OR 37.97; 95%CI 8.97–160.65, p < 0.001) contributed to treatment failure. Susceptibility-guided therapy provided better eradication rate than empirical therapy (97.5% vs. 65.5 %, OR 20.54;…
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