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Background: Japanese guidelines recommend triple therapy with vonoprazan or a proton pump inhibitor (PPI) in combination with antibiotics to treat Helicobacter pylori ( H. pylori ) infection. While studies have shown improved eradication rates and reduced costs with vonoprazan versus PPIs, there is little data describing healthcare resource use (HCRU) and treatment patterns., Objectives: To compare patients treated with a vonoprazan-based or PPI-based regimen for H. pylori infection in Japan in terms of their characteristics, HCRU, healthcare costs, clinical outcomes, and treatment patterns., Design: Retrospective matched cohort., Methods: We used data from the Japan Medical Data Center claims database (July 2014-January 2020) to identify adult patients with H. pylori infection and a first observed use of vonoprazan or a PPI in 2015 or later (index date). Patients prescribed a vonoprazan-based or a PPI-based regimen were matched 1:1 using propensity score matching. HCRU, healthcare costs, diagnostic tests, a proxy for H. pylori eradication (i.e. no triple therapy with amoxicillin in combination with metronidazole or clarithromycin >30 days after the index date), and second-line treatment were described during the 12-month follow-up period., Results: Among 25,389 matched pairs, vonoprazan-treated patients had fewer all-cause and H. pylori- related inpatient stays and outpatient visits than PPI-treated patients, resulting in lower all-cause healthcare costs [185,378 Japanese yen (JPY) versus 230,876 JPY, p  < 0.001]. Over 80% of patients received a post-treatment test for H. pylori . Fewer vonoprazan-treated than PPI-treated patients subsequently received an additional triple regimen for H. pylori infection (7.1% versus 20.0%, p  < 0.001) or a prescription for vonoprazan or a PPI as monotherapy (12.4% versus 26.4%, p  < 0.001) between 31 days and 12 months after the index date., Conclusion: Patients with H. pylori infection who were treated with vonoprazan-based therapy had lower rates of subsequent H. pylori treatment, lower overall and H. pylori -related HCRU, and lower healthcare costs than patients treated with PPI-based therapy., Competing Interests: ES, EEC, and HG are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to Phathom Pharmaceuticals, which funded the development and conduct of this study and manuscript. KY was an employee of Analysis Group, Inc. at the time of study conduct. CP and RJ are employees of Phathom Pharmaceuticals. CWH is a consultant for Phathom Pharmaceuticals, RedHill Biopharma, Allakos, Ironwood, Neurogastrx, ISOThrive, and EndoStim. He is a speaker for RedHill Biopharma, Phathom, and Alnylman. He owns stock in Antibe Therapeutics. KS is a consultant for Fuji Film Inc., Biofermin Pharma, and Pathom Pharmaceuticals. He received lecture fees from Takeda Pharmaceutical, Mylan Inc., Japan, Zeria Pharmaceuticals, Biofermin Pharma, and Astra-Zeneca Japan., (© The Author(s), 2023.)

Objective: Off-pump coronary artery bypass grafting in patients with left ventricular dysfunction has proven to be advantageous. However, it carries risk of emergency conversion to cardiopulmonary bypass. We have successfully used an intra-aortic balloon pump to prevent such conversion. The objective of the present study was to evaluate if intravenous nicorandil infusion reduces the incidence of intraoperative intra-aortic balloon pump insertion., Methods: Consecutive cases of isolated off-pump coronary artery bypass surgery performed by a single surgeon were studied. Patients were divided into two groups. The first group did not receive nicorandil, and the second group received intraoperative nicorandil infusion (started in the operating room after central line insertion)., Results: A total of 375 patients were included in the study. Four patients in the non-nicorandil group and the patients in nicorandil group were on preoperative intra-aortic balloon pump and hence excluded from the study. After routine use of nicorandil infusion, incidence of intra-aortic balloon pump insertion during off-pump coronary artery bypass surgery decreased from 12.4% (21/169) to 2.9% (6/206)., Conclusions: Nicorandil infusion significantly (P = 0.007) reduced the incidence of intra-aortic balloon pump insertion in our series. In patients with left ventricular dysfunction (ejection fraction ≤ 30%), this difference (P = 0.008) assumes a special significance as off-pump bypass surgery is considered high risk in this subset. Nicorandil is an inexpensive drug, and the reduction in cost of surgery by avoiding intra-aortic balloon pump insertion is an added advantage. The use of nicorandil infusion during off-pump coronary artery bypass may result in favorable patient outcomes by reducing invasive intra-aortic balloon pump insertion during off-pump coronary artery bypass grafting.