Laheij RJ, Severens JL, van de Lisdonk EH, Verbeek AL, Jansen JB; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1998; 14: 34.
Department of Gastroenterology, University Hospital, Nijmegen, The Netherlands.
BACKGROUND: Cost-effectiveness analysis, Helicobacter pylori research and the development of proton-pump inhibitors are having more and more impact on the management of dyspepsia. However, clinical trials so far have not included both Helicobacter pylori diagnosis and proton-pump inhibitors in their protocols. METHODS: The study group compromised patients with persistant dyspeptic symptoms, who were referred for upper gastrointestinal endoscopy by their general practitioner. Patients were randomised to prompt endoscopy followed by directed medical treatment (conventional group, n=38) or empirical treatment with omeprazole and in the case of symptom relapse, serological screening for H. pylori infection followed by eradication therapy in seropositive patients (empirical group, n=42). All the patients were asked to record their dyspeptic symptoms, non-medical cost and absenteeism from work in a diary for 1 year. General practitioners were asked to record all diagnostic and therapeutic interventions in these patients in order to be able to calculate the medical costs. RESULTS: In the empirical group, only 13 patients (31%) underwent endoscopy. The average number of days that the patients kept records of their dyspeptic symptoms were 266 (CI 95% 226-307) in the empirical group, of which 166 (CI 95% 128-204) were symptom-free. In the conventional group, 159 (CI 95% 119-198) out of 255 days (CI 95% 209-302) were recorded as symptom-free. The average medical cost in the empirical group was $284 (CI 95% 218-350) and in the conventional group $491 (CI 95% 383-600). In the empirical group, 2 malignancies were found, whereas in the conventional group 1 malignancy was found. CONCLUSIONS: The empirical drug treatment strategy in patients with persistant dyspeptic symptoms resulted in 69% fewer diagnostic endoscopies with lower medical cost and equal effectiveness as compared to prompt endoscopy followed by directed medical treatment.
Publication Types:
Keywords:
- Clinical Trials as Topic
- Costs and Cost Analysis
- Dyspepsia
- Endoscopy
- Endoscopy, Digestive System
- Gastrointestinal Agents
- Helicobacter pylori
- Humans
- Omeprazole
- Randomized Controlled Trials as Topic
- economics
- hsrmtgs
Other ID:
UI: 102234510
From Meeting Abstracts