title: Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care.
abstract: BACKGROUND
  Dyspepsia can be managed by initial endoscopy and treatment based on endoscopic findings, or by empirical prescribing. We aimed to determine the cost effectiveness of initial endoscopy compared with usual management in patients with dyspepsia over age 50 years presenting to their primary care physician.
  
  
  METHODS
  422 patients were recruited and randomly assigned to initial endoscopy or usual management. Primary outcomes were effect of treatment on dyspepsia symptoms and cost effectiveness. Secondary outcomes were quality of life and patient satisfaction. Total costs were calculated from individual patient's use of resources with unit costs applied from national data. Statistical analysis of uncertainty on incremental cost-effectiveness ratio (ICER) was done along with a sensitivity analysis on unit costs with cost-effectiveness acceptability curves.
  
  
  RESULTS
  In the 12 months following recruitment, 213 (84%) patients had an endoscopy compared with 75 (41%) controls. Initial endoscopy resulted in a significant improvement in symptom score (p=0.03), and quality of life pain dimension (p=0.03), and a 48% reduction in the use of proton pump inhibitors (p=0.005). The ICER was Pound Sterling1728 (UK Pound Sterling) per patient symptom-free at 12 months. The ICER was very sensitive to the cost of endoscopy, and could be reduced to Pound Sterling165 if the unit cost of this procedure fell from Pound Sterling246 to Pound Sterling100.
  
  
  CONCLUSIONS
  Initial endoscopy in dyspeptic patients over age 50 might be a cost-effective intervention.
authors.affiliation: Department of Primary Care and General Practice, University of Birmingham, Medical School, Edgbaston. b.c.delaney@bham.ac.uk
authors.forename: B C
authors.initials: BC
authors.lastname: Delaney
authors.forename: S
authors.initials: S
authors.lastname: Wilson
authors.forename: A
authors.initials: A
authors.lastname: Roalfe
authors.forename: L
authors.initials: L
authors.lastname: Roberts
authors.forename: V
authors.initials: V
authors.lastname: Redman
authors.forename: A
authors.initials: A
authors.lastname: Wearn
authors.forename: A
authors.initials: A
authors.lastname: Briggs
authors.forename: F D
authors.initials: FD
authors.lastname: Hobbs
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000175:diagnosis / Q000628:therapy*; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000175:diagnosis / Q000628:therapy; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D013272:Stomach Diseases / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome