Should the economic pillar be included in national, European or global consensuses concerning Helicobacter pylori infection treatments?

The Hellenic Helicobacter pylori (H. pylori) consensus working group published the first national guidelines regarding the Helicobacter pylori infection, to assist physicians in their daily clinical practice [1]. With regard to H. pylori treatment, several eradication regimens have been proposed over the last years with respect to the best approach to antibiotic resistance [2]. H. pylori infection has undoubtedly imposed a notable economic burden on European healthcare systems that has not been evaluated in detail so far [3], especially during the last decade of financial crisis. Liatsos et al [4] recently estimated thoroughly, for the first time in Greece, the expenditures of all available H. pylori eradication treatment regimens. Direct medical costs for a single-attempt outpatient H. pylori eradication treatment were calculated for both prototypes and generics, revealing that regimens based on pantoprazole 40 mg are the most affordable choice, followed by esomeprazole and rabeprazole. Papaefthymiou et al [5] published the first study evaluating the cost effectiveness of H. pylori treatment regimens in Greece, and suggested a 10‐day concomitant regimen with generics using esomeprazole 40 mg as the most appropriate. Given these findings, one might presume that a national or international consensus could include in its statements changes in direct costs concerning first, second or salvage treatment schemes, as well as cost-effectiveness approaches based on relevant studies. Randomized studies concerning the long-term cost benefits after H. pylori eradication treatments seem to be necessary [6,7].

Economic evaluation seems increasingly significant as healthcare systems become more expensive, considering the high prevalence of H. pylori globally. H. pylori treatment costs should be taken into account by the policy-makers of the existing healthcare systems. These data could also be used for the development of specific adjusted strategies for global eradication, aiming at a better as well as less expensive therapeutic approach to the patient.