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

Christos Liatsosa, Apostolis Papaefthymioua, Sotirios D. Georgopoulosb, Jannis Kountourasc

401 Army General Hospital of Athens; Paleo Faliron Hospital, Athens; Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia, Greece

aDepartment of Gastroenterology, 401 Army General Hospital of Athens (Christos Liatsos, Apostolis Papaefthymiou); bDepartment of Gastroenterology, Athens Medical, Paleo Faliron Hospital, Athens (Sotirios D. Georgopoulos); cDepartment of Medicine, Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Macedonia (Jannis Kountouras), Greece

Correspondence to: Christos Liatsos, MD, PhD, FEBGH, Consultant Gastroenterologist, Director of the Gastroenterology Department, 401 General Army Hospital of Athens, Athens 11525, Greece, e-mail:
Received 22 January 2020; accepted 28 January 2020; published online 14 March 2020
© 2020 Hellenic Society of Gastroenterology

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.


1. Georgopoulos S, Michopoulos S, Rokkas T, et al. Hellenic consensus on Helicobacter pylori infection. Ann Gastroenterol 2020;33:105-124.

2. Liatsos C, Georgopoulos SD. Helicobacter pylori best treatment approach:should a national consensus be the best consensus?Ann Gastroenterol 2017;30:704-706.

3. EUROSTAT. Expenditure for selected health care functions by health care financing schemes. 2019. Available from: [Accessed 3 February 2020].

4. Liatsos C, Papaefthymiou A, Kyriakos N, et al. The economic cost per treatment for the Helicobacter pylori eradication treatment schemes in Greece. Helicobacter 2018;23(Suppl 1):e12525 (P02.24). [Abstract]

5. Papaefthymiou A, Liatsos C, Georgopoulos SD, et al. Helicobacter pylori eradication regimens in an antibiotic high-resistance European area:A cost-effectiveness analysis. Helicobacter 2020;25:e12666.

6. Høgh MB, Kronborg C, Hansen JM, Schaffalitzky de Muckadell OB. The cost effectiveness of Helicobacter pylori population screening-economic evaluation alongside a randomised controlled trial with 13-year follow-up. Aliment Pharmacol Ther 2019;49:1013-1025.

7. Vakil N. Editorial:population-based testing for Helicobacter pylori in Western countries. Aliment Pharmacol Ther 2019;49:1360.


Conflict of Interest: None