Cost-effectiveness of medicine vs. endoscopy for dyspeptic patients

Background: Decision analyses conclude that empirical anti-secretory therapy is more cost-effective than endoscopy for managing patients with dyspepsia however RCTs including economic evaluation come to diverging results Aim: to compare the cost-effectiveness of two strategies for management of dyspepsia in primary care 1) endoscopy and 2) empirical proton pump inhibition (PPI) therapy. MethodsA prospective RCT designed to include prospective collection of economic resource data was conducted in general practice from June 2000 to August 2002, Aarhus County, Denmark. 368 patients with dyspepsia were randomly assigned to treatment with omeprazol 40 mg for two weeks (n: 184) or endoscopy (n: 184). Main outcome measures: days free of dyspeptic symptoms and proportion of patients symptomatic after one year. Cost were estimated from patients' and GPs' questionnaire and from medical records. ResultsThe incremental cost effectiveness (CE) ratio for one day free of dyspeptic symptoms using the endoscopy strategy was €/day 300 compared with the PPI strategy. The incremental CE ratio for one patient free of dyspeptic symptoms after one year using the endoscopy strategy was € 13,600 based on the patients' evaluation. The PPI strategy was both cheaper and more effective when reflux was the predominant symptom. ConclusionEndoscopy was associated with a small, non-significant improvement in patients' health status compared with empirical PPI, but it was the more costly of the two strategies. The empirical PPI strategy was hence the more cost-effective strategy for managing patients with dyspepsia in general practice especially if reflux was the predominant symptom.