Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care.
OBJECTIVE
To determine the cost effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia.


METHODS
Randomised controlled trial.


METHODS
31 UK primary care centres.


METHODS
478 patients under 50 years old presenting with dyspepsia of longer than four weeks duration.


METHODS
Near patient testing for H pylori and open access endoscopy for patients with positive results. Control patients received acid suppressing drugs or specialist referral at general practitioner's discretion.


METHODS
Cost effectiveness based on improvement in symptoms and use of resources at 12 months; quality of life.


RESULTS
40% of the study group tested positive for H pylori. 45% of study patients had endoscopy compared with 25% of controls. More peptic ulcers were diagnosed in the study group (7.4% v 2.1%, P=0.011). Paired comparison of symptom scores and quality of life showed that all patients improved over time with no difference between study and control groups. No significant differences were observed in rates of prescribing, consultation, or referral. Costs were higher in the study group ( 367.85 pound sterling v 253.16 pound sterling per patient).


CONCLUSIONS
The test and endoscopy strategy increases endoscopy rates over usual practice in primary care. The additional cost is not offset by benefits in symptom relief or quality of life.
Delaney
B C
BC
Department of Primary Care and General Practice, Division of Primary Care, Public and Occupational Health, University of Birmingham Medical School, Birmingham B15 2TT, UK. b.c.delaney@bham.ac.uk
Wilson
S
S
Roalfe
A
A
Roberts
L
L
Redman
V
V
Wearn
A
A
Hobbs
F D
FD
D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal / Q000191:economics / Q000379:methods; D005194:Family Practice; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis*; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000191:economics; D011379:Prognosis; D011788:Quality of Life