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Test and treat followed by endoscopy for non-responders was less cost effective than empiric proton pump inhibitor (PPI) treatment followed by endoscopy or with strategies of test and treat followed by empiric PPI (or vice versa).
Decision analysis can be used to bridge the gap between evidence and practice. It may be used to highlight the best choice between competing management strategies where no direct trial evidence is available or add additional information, for example cost data, to extrapolate from available trial evidence.1 The use of sensitivity analysis, changing the parameters such as the prevalence of Helicobacter pylori, is particularly helpful in establishing an “envelope” within which a particular strategy is cost effective. Trials, meta-analyses, and modelling can be seen as working together to create a practical quantified evidence base.
Background: Several consensus statements have recommended Helicobacter pylori testing and eradication (test and treat) followed by endoscopy for non-responders for the management of simple uninvestigated dyspepsia, particularly in patients aged <45 years. However, recent trials have suggested that this may not be such a good strategy.
Question: For uninvestigated …