Reappraisal of non-invasive management strategies for uninvestigated dyspepsia: a cost-minimization analysis
dc.contributor.author | Ladabaum, Uri | en_US |
dc.contributor.author | Chey, William D. | en_US |
dc.contributor.author | Scheiman, James M. | en_US |
dc.contributor.author | Fendrick, A. Mark | en_US |
dc.date.accessioned | 2010-06-01T22:46:55Z | |
dc.date.available | 2010-06-01T22:46:55Z | |
dc.date.issued | 2002-08 | en_US |
dc.identifier.citation | Ladabaum, U.; Chey, W. D.; Scheiman, J. M.; Fendrick, A. M. (2002). "Reappraisal of non-invasive management strategies for uninvestigated dyspepsia: a cost-minimization analysis." Alimentary Pharmacology & Therapeutics 16(8): 1491-1501. <http://hdl.handle.net/2027.42/75747> | en_US |
dc.identifier.issn | 0269-2813 | en_US |
dc.identifier.issn | 1365-2036 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/75747 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=12182749&dopt=citation | en_US |
dc.description.abstract | Background : The benefits of the Helicobacter pylori test-and-treat strategy are attributable largely to the cure of peptic ulcer disease while limiting the use of endoscopy. Aim : To reappraise the test-and-treat strategy and empirical proton pump inhibitor therapy for the management of uninvestigated dyspepsia in the light of the decreasing prevalence of H. pylori infection, peptic ulcer disease and peptic ulcer disease attributable to H. pylori . Methods : Using a decision analytical model, we estimated the cost per patient with uninvestigated dyspepsia managed with the test-and-treat strategy ($25/test; H.pylori treatment, $200) or proton pump inhibitor ($90/month). Endoscopy ($550) guided therapy for persistent or recurrent symptoms. Results : In the base case (25% H. pylori prevalence, 20% likelihood of peptic ulcer disease, 75% of ulcers due to H.pylori ), the cost per patient is $545 with the test-and-treat strategy and $529 with proton pump inhibitor, and both strategies yield similar clinical outcomes at 1 year. H. pylori prevalence, the likelihood of peptic ulcer disease and the proportion of ulcers due to H.pylori are important determinants of the least costly strategy. At an H. pylori prevalence below 20%, proton pump inhibitor is consistently less costly than the test-and-treat strategy. Conclusions : As the H. pylori prevalence, the likelihood of peptic ulcer disease and the proportion of ulcers due to H. pylori decrease, empirical proton pump inhibitor becomes less costly than the test-and-treat strategy for the management of uninvestigated dyspepsia. Given the modest cost differential between the strategies, the test-and-treat strategy may be favoured if patients without peptic ulcer disease derive long-term benefit from H.pylori eradication. | en_US |
dc.format.extent | 155855 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Science Ltd | en_US |
dc.rights | 2002 Blackwell Science Ltd | en_US |
dc.title | Reappraisal of non-invasive management strategies for uninvestigated dyspepsia: a cost-minimization analysis | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Otolaryngology | en_US |
dc.subject.hlbsecondlevel | Pharmacy and Pharmacology | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | ** Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies (CHOICES), University of Michigan, Ann Arbor, MI, USA | en_US |
dc.contributor.affiliationother | † Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA; Divisions of | en_US |
dc.contributor.affiliationother | † Gastroenterology and | en_US |
dc.contributor.affiliationother | § General Medicine, Department of Internal Medicine, | en_US |
dc.contributor.affiliationother | ¶ Department of Health Management and Policy, School of Public Health, | en_US |
dc.identifier.pmid | 12182749 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/75747/1/j.1365-2036.2002.01306.x.pdf | |
dc.identifier.doi | 10.1046/j.1365-2036.2002.01306.x | en_US |
dc.identifier.source | Alimentary Pharmacology & Therapeutics | en_US |
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