Evaluation of dyspepsia and functional gastrointestinal disorders: a cost-benefit analysis of different approaches.
OBJECTIVE
To establish a decision rule for diagnostic testing in patients with dyspepsia.


METHODS
Medical decision analysis using a decision-tree model.


METHODS
Costs and benefits associated with two alternative strategies are compared. In the first strategy, empirical therapy alone is provided. The second strategy also includes tests to diagnose the cause of dyspepsia.


RESULTS
It is more beneficial to test than to employ empirical treatment alone if the a-priori probability P of an organic disease is larger than the ratio of the costs T of testing to the costs C of a missed diagnosis: P > T/C. In most clinical situations, the costs of a missed diagnosis outweigh the costs of testing by a factor of 5-10, for which the cost ratio is 10-20%.


CONCLUSIONS
Diagnostic tests should be performed in patients with dyspepsia, whenever the probability of finding organic disease exceeds the ratio of the cost of testing to the cost of missing this diagnosis.
Sonnenberg
A
A
Division of Gastroenterology, VA Medical Center, Milwaukee, Wisconsin, USA.
Townsend
W F
WF
Müller
A D
AD
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000706:statistics & numerical data; D004415:Dyspepsia / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D006801:Humans