[Costs and effectiveness of diagnosis and treatment of patients with dyspepsia, determined with the aid of a computer model].
A theoretical investigation was carried out to determine whether the use of an antibody test for Helicobacter pylori (HP) and the use of bismuth oxide with optional antibiotics, would be cost effective in the diagnosis and treatment of patients with dyspepsia. With literature data on therapeutic effectiveness a computer simulation was carried out. A quick antibody test reduced the number of gastroscopic investigations necessary. Gastroscopic investigation still had to be carried out for patients suffering from non-HP-related dyspepsia. This strategy not only reduced costs, but enabled the general practitioner to start treating the patient immediately. The treatment of a HP-related gastritis with histamine receptor blockers (cimetidine, ranitidine) proved less effective than treatment with bismuth oxide, and more expensive. The treatment with bismuth oxide combined with antibiotics, the so called triple treatment, proved to be the most effective, however disproportionately more expensive. Although the interpretation of the serological test is not without problems, treating dyspepsia with bismuth oxide, especially when the HP serological test result is positive, is the cheaper option and achieves the required effectiveness.
Schipper
C K
CK
Erasmus Universiteit, Instituut voor Medische Technology Assessment, Rotterdam.
Rutten
F F
FF
Loffeld
R J
RJ
D001729:Bismuth / Q000627:therapeutic use; D002927:Cimetidine / Q000627:therapeutic use; D002985:Clinical Protocols; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D011899:Ranitidine / Q000627:therapeutic use
D002927:Cimetidine; D011899:Ranitidine; C033301:bismuth oxide; D001729:Bismuth