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Cost-effectiveness analysis of two management strategies for dyspepsia

  • Hans C. Kjeldsen (a1), Mickael Bech (a2) and Bo Christensen (a1)

Abstract

Objectives: To compare the cost-effectiveness of endoscopy and empirical proton pump inhibition (PPI) therapy for management of dyspepsia in primary care.

Methods: A randomized controlled trial, including prospective collection of economic resource data, was conducted in general practice from June 2000 to August 2002, Aarhus County, Denmark. We randomly assigned 368 dyspeptic patients from thirty-two general practices to treatment with omeprazol 40 mg for 2 weeks (n=184) or endoscopy (n=184). The study adopted a societal perspective, and the year of costing was 2006. Outcome measures: days free of dyspeptic symptoms and proportion of patients with dyspepsia after 1 year based on patients' and general practitioners' (GPs) assessment. Costs were estimated from patient and GP questionnaires and from medical records.

Results: The incremental cost-effectiveness (CE) ratio for 1 day free of dyspeptic symptoms using the endoscopy strategy was €/day 154 compared with the PPI strategy. The incremental CE ratio for one person free of dyspeptic symptoms after 1 year using the endoscopy strategy was €13,905 based on the patients' evaluation, and the incremental CE ratio for one person free of predominant symptoms after 1 year was €5,990 according to the GPs' evaluation. The PPI strategy was both cheaper and more effective than the endoscopy strategy when reflux was the predominant symptom.

Conclusions: A strategy using empirical antisecretory PPI therapy should be recommended if the alternative is an endoscopy strategy for managing dyspeptic patients in general practice, especially if reflux was the predominant symptom.

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References

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Agreus L, Borgquist L. 2002 The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden. Pharmacoeconomics. 20: 347355.
Bashford JN, Norwood J, Chapman SR. 1998 Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. BMJ. 317: 452456.
Bech M, Gyrd-Hansen D. 2000 Cost implications of routine mammography screening of women 50–69 years in the county of Funen, Denmark. Health Policy. 54: 125141.
Briggs AH, Wonderling DE, Mooney CZ. 1997 Pulling cost-effectiveness analysis up by its bootstraps: A non-parametric approach to confidence interval estimation. Health Econ. 6: 327340.
Bytzer P. 1999 Cost-effectiveness of gastroscopy. Ital J Gastroenterol Hepatol. 31: 749760.
Bytzer P, Hansen JM, Schaffalizky De Muckadell OB. 1994 Empirical H2-blocker therapy on prompt endoscopy in management of dyspepsia. Lancet. 343: 811816.
Bytzer P, Talley NJ. 2001 Dyspepsia. Ann Intern Med. 134: 815822.
Delaney B, Ford A, Forman D, et al. 2005; Initial management strategies for dyspepsia. Cochrane Database Syst Rev. CD001961.
Delaney B, Moayyedi P, Deeks J, et al. 2000 The management of dyspepsia: A systematic review. Health Technol Assess. 4: iii189.
Delaney BC, Wilson S, Roalfe A, et al. 2000 Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: A randomised controlled trial in primary care. Lancet. 356: 19651969.
Ebell MH, Warbasse L, Brenner C. 1997 Evaluation of the dyspeptic patient: A cost-utility study. J Fam Pract. 44: 545555.
El-Serag HB, Talley NJ. 2004 Systemic review: The prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 19: 643654.
Fendrick AM, Chernew ME, Hirth RA, et al. 1995 Alternative management strategies for patients with suspected peptic ulcer disease. Ann Intern Med. 123: 260268.
Fenwick E, O'Brien BJ, Briggs A. 2004 Cost-effectiveness acceptability curves-facts, fallacies and frequently asked questions. Health Econ. 13: 405415.
Garcia-Altes A, Jovell E. 2001 Economic analysis of treatment of functional dyspepsia. An assessment of the quality of published studies. Int J Technol Assess Health Care. 17: 517527.
Gardner MJ, Altman DG. 1989: Estimation rather than hypothesis testing: Confidence intervals rather than P values. In: Gardner MJ, Altman DG, eds. Statistic with confidence. London: BMJ; 619.
Gold MR, Siegel JE, Russell LB, et al. 1996. Cost-effectiveness in health and medicine. Oxford: Oxford University Press;
Heikkinen M, Pikkarainen P, Takala J, et al. 1996 General practitioners' approach to dyspepsia. Survey of consultation frequencies, treatment, and investigations. Scand J Gastroenterol. 31: 648653.
Hirth RA, Bloom BS, Chernew ME, et al. 2000 Patient, physician, and payer perceptions and misperceptions of willingness to pay for diagnostic certainty. Int J Technol Assess Health Care. 16: 3549.
Huang J, Lam SK, Malfertheiner P, et al. 2003 Has education about Helicobacter pylori infection been effective? Worldwide survey of primary care physicians. J Gastroenterol Hepatol. 18: 512520.
Kjeldsen HC. 2005. Dyspepsia in general practice—Reasons to consult, management strategies and health economic consequences. Aarhus: Faculty of Health Science, University of Aarhus;
Kristiansen IS, Gyrd-Hansen D. 2004; Cost-effectiveness analysis based on the number-needed-to-treat: Common sense or non-sense? Health Econ. 13: 919.
Laheij RJ, Severens JL, Jansen JB, et al. 1997 Management in general practice of patients with persistent dyspepsia. A decision analysis. J Clin Gastroenterol. 25: 563567.
Laheij RJ, Severens JL, Van de Lisdonk EH, et al. 1998 Randomized controlled trial of omeprazole or endoscopy in patients with persistent dyspepsia: A cost-effectiveness analysis. Aliment Pharmacol Ther. 12: 12491256.
Lassen AT, Hallas J, Schaffalitzky de Muckadell OB. 2004 Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients: 6.7 year follow up of a randomised trial. Gut. 53: 17581763.
Lewin-Van Den Broek NT. 1999. Diagnostic and therapeutic strategies. Utrecht: University Utrecht;
Makris N, Barkun A, Crott R, et al. 2003 Cost-effectiveness of alternative approaches in the management of dyspepsia. Int J Technol Assess Health Care. 19: 446464.
Mandelblatt JS, Fryback DG, Weinstein MC, et al. 1997 Assessing the effectiveness of health interventions for cost-effectiveness analysis. Panel on Cost-Effectiveness in Health and Medicine. J Gen Intern Med. 12: 551558.
Martin RM, Lim AG, Kerry SM, et al. 1998 Trends in prescribing H2-receptor antagonists and proton pump inhibitors in primary care. Aliment Pharmacol Ther. 12: 797805.
Nyren O, Lindberg G, Lindstrom E, et al. 1992 Economic costs of functional dyspepsia. Pharmacoeconomics. 1: 312324.
Ofman JJ, Rabeneck L. 1999 The effectiveness of endoscopy in the management of dyspepsia: A qualitative systematic review. Am J Med. 106: 335346.
Posnett J, Jan S. 1996 Indirect cost in economic evaluation: The opportunity cost of unpaid inputs. Health Econ. 5: 1323.
Schwartz LM, Woloshin S, Welch HG. 1996 Trends in diagnostic testing following a national guideline for evaluation of dyspepsia. Arch Intern Med. 156: 873875.
Scott BB. 1995 Gastroenterology in the Trent Region in 1992 and a review of changes since 1975. Gut. 36: 468472.
Sculpher M. 2001: The role and estimation of productivity costs in economic evaluation. In: Drummond M, McGuire A, eds. Economic evaluation in health care merging theory with practice. Oxford: Oxford University Press; 94112.
Severens JL, Laheij RJ, Jansen JB, et al. 1998 Estimating the cost of lost productivity in dyspepsia. Aliment Pharmacol Ther. 12: 919923.
Silverstein MD, Petterson T, Talley NJ. 1996 Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: A decision analysis. Gastroenterology. 110: 7283.
Spiegel BM, Vakil NB, Ofman JJ. 2002 Dyspepsia management in primary care: A decision analysis of competing strategies. Gastroenterology. 122: 12701285.
Talley NJ, Colin-Jones DG, Koch KL, et al. 1991: Functional dyspepsia: A classification with guidelines for diagnosis and management. Gastroenterology. 145160.
Westbrook JI. 2002 Trends in the utilization of diagnostic upper GI endoscopy in New South Wales, Australia, 1988 to 1998. Gastrointest Endosc. 55: 847853.
Westbrook JI, Duggan AE, McIntosh JH. 2001 Prescriptions for antiulcer drugs in Australia: Volume, trends, and costs. BMJ. 323: 13381339.
Westbrook JI, Rushworth RL, Rob MI, et al. 1993 Diagnostic procedures and health outcomes. Upper gastrointestinal tract investigations in the elderly. Med J Aust. 159: 242245.
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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
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