Gastroenterology

Gastroenterology

Volume 122, Issue 5, May 2002, Pages 1270-1285
Gastroenterology

Clinical Research
Dyspepsia management in primary care: A decision analysis of competing strategies

Presented at the AGA Dyspepsia Research Forum at Digestive Disease Week, May 2001, Atlanta, Georgia.
https://doi.org/10.1053/gast.2002.33019Get rights and content

Abstract

GASTROENTEROLOGY 2002;122:1270-1285

Section snippets

Materials and methods

Decision analysis is a quantitative method for estimating the financial costs and clinical outcomes of alternative management strategies under conditions of uncertainty. Using decision analysis software,58 we evaluated the cost-effectiveness of 4 sequential empiric strategies for patients with dyspepsia (Figure 1). One pair of strategies begins with H. pylori testing, followed by either endoscopy or a PPI trial for nonresponders, whereas the other pair begins with a PPI trial, followed by

Results

We estimated the potential clinical and economic impact of implementing the 4 alternative strategies in separate cost-effectiveness and cost-utility analyses (Tables 5 and 6).The PPI→EGD strategy generated the lowest cost per patient, $1628, compared with $1902 for the strategy supported by current guidelines (T&T→EGD). The T&T→PPI→EGD strategy cost $1680 per patient, and the PPI→T&T→EGD strategy cost $1788 per patient. The T&T→PPI→EGD and PPI→T&T→EGD strategies were most effective in both

Discussion

This analysis of alternative management strategies for uninvestigated dyspepsia suggests that the current guidelines may not be the most cost-effective approach. Compared with the current guidelines, interposing a 6-week PPI trial between test and treat and upper endoscopy may improve symptomatic relief at 1 year while reducing costs by substantially minimizing the endoscopic burden. Our analysis reveals that the use of PPI therapy before endoscopy may serve as a filter to identify patients who

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