Alternative management strategies for patients with suspected peptic ulcer disease.
OBJECTIVE
To estimate the clinical and economic effects of available invasive and noninvasive management strategies for peptic ulcer and Helicobacter pylori in persons with symptoms suggesting peptic ulcer disease.


METHODS
Cost-effectiveness analysis using a decision analytic model.


METHODS
2 immediate endoscopy and 3 noninvasive diagnostic and treatment strategies were evaluated: 1) immediate endoscopy for peptic ulcer and biopsy for H. pylori; 2) immediate endoscopy without biopsy; 3) serologic test for H. pylori; 4) empiric treatment with antisecretory therapy; and 5) empiric treatment with antisecretory therapy and antibiotic agents to eradicate H. pylori.


METHODS
Cost per ulcer cured and cost per patient treated.


RESULTS
The estimated costs per ulcer cured by strategy were as follows: 1) endoscopy and biopsy for H. pylori, $8045; 2) endoscopy without biopsy, $6984; 3) serologic test for H. pylori, $4541; 4) empiric antisecretory therapy, $4835; and 5) empiric antisecretory and antibiotic therapy, $4155. The predicted costs per patient treated were as follows: 1) endoscopy and biopsy for H. pylori, $1584; 2) endoscopy without biopsy, $1375; 3) serologic test for H. pylori, $894; 4) empiric antisecretory therapy, $952; and 5) empiric antisecretory and antibiotic therapy, $818. The cost-effectiveness advantage of the noninvasive strategies diminished as the cost of endoscopy decreased or as the probability of recurrent symptoms increased in patients initially managed without endoscopy.


CONCLUSIONS
Endoscopy, although costly, precisely guided diagnosis and treatment and thus potentially reduced the number of patients inappropriately treated. However, the safety and effectiveness of less expensive, less invasive diagnostic and treatment strategies strongly support initial noninvasive care of symptomatic persons thought to have peptic ulcer disease.
Fendrick
A M
AM
University of Michigan School of Medicine, Ann Arbor, USA.
Chernew
M E
ME
Hirth
R A
RA
Bloom
B S
BS
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001706:Biopsy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal / Q000191:economics; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D010437:Peptic Ulcer / Q000188:drug therapy* / Q000382:microbiology; D012008:Recurrence
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents