Am J Gastroenterol

Which first-line H. pylori regimen is most cost‑effective?

January 26, 2026

Using a Markov model of treatment‑naïve U.S. adults, investigators compared five first‑line H. pylori regimens across short‑ and long‑term horizons. Bismuth quadruple therapy (BQT) had the lowest lifetime cost per patient ($193,651) and served as the reference strategy. Rifabutin triple therapy achieved an incremental cost‑effectiveness ratio (ICER) of $45,971 per quality‑adjusted life‑year (QALY) gained, while vonoprazan triple therapy had a substantially higher ICER ($290,572/QALY). Clarithromycin triple and vonoprazan dual therapies were dominated by BQT. Rifabutin triple therapy showed the highest net monetary benefit and greatest probability of cost‑effectiveness at $100,000–$150,000/QALY thresholds.

Clinical takeaway: For treatment‑naive patients in the U.S., prioritize bismuth quadruple therapy as first-line H. pylori treatment, with rifabutin triple therapy as a high-value alternative when appropriate.

Source:

Liu L, et al. (2026, January 21). Am J Gastroenterol. Cost-effectiveness of first-line regimens for Helicobacter pylori infection in the United States. https://pubmed.ncbi.nlm.nih.gov/41563134/