Language
English
Publication Date
1-1-2026
Journal
Helicobacter
DOI
10.1111/hel.70152
PMID
42483780
PMCID
PMC13389828
PubMedCentral® Posted Date
7-22-2026
PubMedCentral® Full Text Version
Post-print
Abstract
Background: The price of vonoprazan in the United States, as with many newly introduced drugs, is currently high. Here, we examined the cost-effectiveness of vonoprazan clarithromycin triple therapy for treatment of Helicobacter pylori in the United States. We compared cure rates and total treatment costs to achieve ≥ 90% cure with either vonoprazan or proton pump inhibitor (PPI) triple therapy.
Materials and methods: We simulated a theoretical population and compared 4 scenarios comparing vonoprazan 20 mg twice daily or esomeprazole 40 mg twice daily. These included: (1) empiric vonoprazan versus esomeprazole clarithromycin triple therapy, (2) susceptibility-based vonoprazan versus esomeprazole clarithromycin triple therapy, (3) empiric vonoprazan versus esomeprazole clarithromycin triple therapy with treatment failures receiving bismuth quadruple therapy, and (4) susceptibility-based vonoprazan versus esomeprazole clarithromycin triple therapy with treatment failures receiving bismuth quadruple therapy. The prevalence of clarithromycin resistance was estimated at 30%. Cure rates were based on the H. pylori treatment nomogram and drug costs on U.S. 2025 retail prices (i.e., $50 for PPI and $960 for vonoprazan triple therapy).
Results: With 30% resistance, susceptibility-based therapy was the most effective (cure rate 92%). With empiric therapy, the cure rate with vonoprazan was higher than esomeprazole (88% vs. 77%) but overall costs increased 2.4-5.2 times. The cost per 1000 patients receiving vonoprazan was approximately $1000,000 versus $50,000 for esomeprazole. The least expensive, highly effective scenario was empiric esomeprazole triple therapy with treatment failures receiving bismuth quadruple therapy.
Conclusions: Any treatment advantage of vonoprazan over PPI in clarithromycin triple therapy is restricted to those with clarithromycin resistance. Vonoprazan triple therapies cost 2 to 5 times more than a high potency PPI with small gains in cure rates. For susceptible infections, triple therapy using a high potency PPI should be preferred, and the most cost-effective strategy is to reserve vonoprazan for refractory cases.
Keywords
Pyrroles, Sulfonamides, Proton Pump Inhibitors, Helicobacter Infections, Humans, Helicobacter pylori, Drug Therapy, Combination, Anti-Bacterial Agents, Pyrrolidines, Cost-Benefit Analysis, United States, Clarithromycin, Cost-Effectiveness Analysis, comparison, cost‐effective, Helicobacter pylori, proton pump inhibitor, therapy, United States, vonoprazan
Published Open-Access
yes
Recommended Citation
Mimi C Tan, Robert L Atmar, and David Y Graham, "High Potency Proton Pump Inhibitor Versus Vonoprazan in Helicobacter pylori Triple Therapy" (2026). Faculty, Staff and Students Publications. 8760.
https://digitalcommons.library.tmc.edu/baylor_docs/8760