Long-term costs after gastroenterology consultation with endoscopy versus radiography in dyspepsia.
A randomized clinical trial assessed the medical costs during 6 months after the evaluation of dyspepsia by gastroenterology consultation with esophagogastroduodenoscopy versus barium radiography. Primary care physicians entered patients whose dyspepsia responded incompletely to empiric therapy or recurred. The consultation/endoscopy group (N = 32) was similar (p greater than 0.23) to the radiography group (N = 34) regarding age, gender, physician visits, and costs of all dyspepsia drugs and H2 blockers during 6 months before evaluation. Most patients had non-ulcer dyspepsia. Costs during the succeeding 6 months (consultation/endoscopy versus radiography groups) were physician visits ($33.1 +/- 14.5 vs. $114.2 +/- 23.3, p less than 0.005); radiologic procedures ($70.5 +/- 37.3 vs. $67.6 +/- 22.5, p greater than 0.30); all dyspepsia drugs ($30.4 +/- 10.0 vs. $100.1 +/- 36.8, p = 0.08); H2 blockers ($25.4 +/- 9.5 vs. $96.0 +/- 34.7, p = 0.06); and total cost ($134.0 +/- 43.8 vs. $435.3 +/- 93.9, p = 0.006). The higher total cost in the radiography group was partly due to the referral of 7 patients (21%) for gastroenterology consultation due to persistent dyspepsia, 6 of whom had endoscopy versus the performance of radiography in 0 of the 32 consultation/endoscopy patients (p less than 0.025). Dyspepsia self-ratings were similar.
Longstreth
G F
GF
Department of Medicine, Southern California Permanente Medical Group, San Diego.
D000328:Adult; D001466:Barium Sulfate / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data; D004064:Digestive System / Q000000981:diagnostic imaging*; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal / Q000191:economics* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D005762:Gastroenterology / Q000191:economics* / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D011859:Radiography; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data
D001466:Barium Sulfate