Evaluation of the Dyspeptic Patient
Since dyspepsia is a common problem in primary care, guidance in choosing which of the numerous approaches available to treat the disorder from a cost-effectiveness standpoint is of interest. This report analyzed strategies that considered an adult presenting to an outpatient setting with clinical dyspepsia (defined as "intermittent pain in the upper abdomen caused by disease of the esophagus, stomach, and/or duodenum of at least two weeks’ duration, typically associated with gas, eructations, bloating, and nausea"). Patients with signs of serious or complicated disease were not considered.
Seven strategies were considered: 1) eradicate H. pylori empirically (omeprazole + clarithromycin + amoxicillin or metronidazole); 2) omeprazole alone empirically; 3) endoscopy or 4) UGI and Rx if H. pylori-positive; 5) treat H. pylori titer if positive; 6) endoscopy or 7) UGI treatment for H. pylori if positive, with ulcer demonstrated.
Three strategies1, 2, and 5were roughly equal in cost per dyspeptic patient and cost-effectiveness. Strategy #1 was associated with the lowest probability of symptomatic ulcer recurrence and death. Each of these evaluations is based upon certain price, efficacy, and outcome assumptions. For instance, were the price of UGI to go down, to perhaps less than $50, then strategy #7 becomes about equivalent to the others. If the price of an H. pylori titer were to go down 25% or the price of antibiotics were to go up 25%, method #5 becomes the most cost- effective.
Ebell M, et al. J Fam Pract 1997;44: 545-555.
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