Garcia-Altes A, Rota R, Barenys M, Abad A; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2002; 18: abstract no. 103.

Catalan Agency for Health Technology Assessment; Instituto de Investigacion en Servicios Sanitarios, Travessera de les Corts 131-159, Barcelona, agarcia@hsph.harvard.edu

BACKGROUND/OBJECTIVES: Dyspepsia is a very prevalent condition with high impact in terms of cost. The objective of this study was to systematically assess the effectiveness and cost-effectiveness of five different strategies for the management of dyspepsia, i.e. prompt endoscopy, score and scope, test and scope, test and treat, and empirical antisecretory therapy. METHODS: A decision analysis was performed to compare the effectiveness and cost-effectiveness of the alternatives for the management of dyspepsia. The decision model considered patients (older and younger than 45 years) that consult the general practitioner with uncomplicated dyspepsia. Data on diagnostic accuracy of the diagnostic tests, effectiveness data of the two drug treatments, prevalence of different diagnosis of dyspepsia in primary care population, and rates of H. pylori infection were included. The perspective of analysis used was that of the public health care payer, and the time-horizon established was one year post-therapy. Only direct costs were included. The measure of the economic analysis was cost per asymptomatic patient, valued in 2001 Euros. Different one-way and two-way sensitivity analyses were performed to test the robustness of both model and results obtained. RESULTS: Endoscopy was found to be the most effective strategy for the management of dyspepsia, followed by score, test and scope, test and treatment, and empirical therapy. Regarding cost-effectiveness results, empirical treatment was the most cost-effective alternative followed by test and treat, score, and endoscopy. For patients younger than 45 years, the most effective strategy was endoscopy, followed by test and scope, score, test and treat, and empirical therapy group. In terms of incremental cost-effectiveness, and for patients older than 45 years, empirical therapy was the most cost-effective strategy, followed by test and treat, and endoscopy. For patients younger than 45 years, empirical therapy was the most cost-effective strategy, followed by test and treat, score, and endoscopy. DISCUSSION: Our conclusions would be oriented to recommend a non invasive strategy (test and treat) for patients younger than 45 years mainly based in its cost-effectiveness and the fact that the very low risk of malignant disease in this group. For patients older than 45 years, we would recommend endoscopy, since it is the most effective strategy, and has a slightly higher incremental cost-effectiveness than test and treat strategy.

Publication Types:

• Meeting Abstracts

Keywords:

• Aged
• Cost-Benefit Analysis
• Decision Support Techniques
• Dyspepsia
• Endoscopy
• Humans
• Primary Health Care
• Research Design
• economics
• instrumentation
• methods
• hsrmtgs

Other ID:

• GWHSR0003040

UI: 102274719

From Meeting Abstracts