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Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori for management of dyspepsia: A randomized trial in primary care

Published online by Cambridge University Press:  09 August 2006

Dorte Ejg Jarbol ,
Mickael Bech ,
Jakob Kragstrup ,
Troels Havelund  and
Ove B. Schaffalitzky de Muckadell
Dorte Ejg Jarbol
Affiliation:
University of Southern Denmark
Mickael Bech
Affiliation:
University of Southern Denmark
Jakob Kragstrup
Affiliation:
University of Southern Denmark
Troels Havelund
Affiliation:
University of Southern Denmark and Odense University Hospital
Ove B. Schaffalitzky de Muckadell
Affiliation:
University of Southern Denmark and Odense University Hospital
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Abstract

Objectives: An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care.

Methods: A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n=722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined.

Results: The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms.

Conclusions: Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

Keywords

DyspepsiaHelicobacter pyloriHealthcare costsPrimary health careAntiulcer agents
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 22 , Issue 3 , July 2006 , pp. 362 - 371
Copyright
© 2006 Cambridge University Press

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