Wang T, Meyers J, Davis K, Madhwani S, Boklage S. Patterns of H. pylori treatment and testing for patients in a commercially insured population. Poster presented at the AMCP's 27th Annual Meeting & Expo; April 1, 2015. San Diego, CA. [abstract] J Manag Care Pharm. 2015 Apr; 21(4-a):S11.

BACKGROUND: According to the CDC, up to 50% of all antibiotics prescribed are potentially not needed or not optimally prescribed. The overuse of antibiotics may lead to serious health consequences such as C. difficile or other potentially high cost utilization of services. H. pylori is a common chronic bacterial infection that can lead to serious longterm consequences if not tested and properly treated with antibiotics.

The purpose of this database analysis was to examine the real-life patterns of H. pylori treatment and eradication testing.

METHODS: The utilization of H. pylori tests (i.e., endoscopy, urea breath tests, serum antigen tests, and fecal antigen test) as well as antibiotic treatments between January 1, 2008, and December 31, 2012 were evaluated using the MarketScan Research Databases (first observed antibiotic prescription for H. pylori treatment was termed the index date). Patients aged > 18 years with continuous health plan enrollment for 6 months pre- and up to 6 months post-index date were analyzed. H. pylori-related treatment was defined as > 2 specific antibiotics for H. pylori eradication (i.e., amoxicillin, clarithromycin, metronidazole, tetracycline, tinidazole, levofloxacin including fixed dose combinations) with or without an antacid within 7 days.

RESULTS: During this 5-year period, 169,853 patients received at least one course of H. pylori-related treatment, but only 41.1% had an H. pylori test preceding treatment, suggesting treatment without proper testing. Furthermore, only 1 in 8 patients (12.7%) receiving H. pylori treatment were retested to confirm eradication in the 6 months after their index date. High-cost endoscopy accounted for 53.3% of the confirmatory tests despite the availability of non-invasive, less expensive, but highly accurate test options. Approximately 22% of patients received 2nd line treatment, and 30% of these patients received the same 2nd line treatment as they received in 1st line despite prior treatment failure.

CONCLUSIONS: There appears to be no improvement in the use of testing prior to treatment for H. pylori infection since the publication of American College of Gastroenterology clinical guideline in 2007. The treatment of patients with antibiotics without proper testing for infection and confirming eradication in the era of increased antibiotic resistance can lead to negative health outcomes and potentially unnecessary treatments. Additionally, the overuse of expensive testing options places additional burden on an already strained healthcare systems.

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