Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: a decision analysis.
OBJECTIVE
Empirical therapy has been proposed for initial management of dyspepsia. The aim of this study was to evaluate initial endoscopy, empirical therapy, and testing for Helicobacter pylori in the management of patients with a new onset of dyspepsia.


METHODS
Decision analysis was used to compare the direct medical charges in the first year after the onset of dyspepsia for patients managed by initial endoscopy or empirical therapy, with or without initial testing for H. pylori.


RESULTS
Medical care charges were $2162.50 for initial endoscopy and $2122.60 for empirical therapy, a difference of 1.8%. For a 55-year-old adult, life expectancy was 23.49 years for initial endoscopy compared with 23.48 years for empirical therapy. Empirical therapy has lower charges than initial endoscopy when H2-receptor antagonists are used to prevent recurrence of dyspepsia. Initial noninvasive testing for H. pylori has lower charges than initial endoscopy if patients with dyspepsia with H. pylori receive antimicrobial therapy without endoscopy but would have higher charges if patients with H. pylori routinely have endoscopy.


CONCLUSIONS
Surprisingly, the choice of optimal management strategy was a "toss-up." Only modest savings may result from practice guidelines that recommend empirical therapy in the management of patients with dyspepsia.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
M D
MD
Silverstein
T
T
Petterson
N J
NJ
Talley
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003661:Decision Support Techniques; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D004724:Endoscopy; D017048:Health Care Costs; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists