The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis.
OBJECTIVE
The evidence that proton pump inhibitor (PPI) therapy affects symptoms of nonulcer dyspepsia is conflicting. We conducted a systematic review to evaluate whether PPI therapy had any effect in nonulcer dyspepsia and constructed a health economic model to assess the cost-effectiveness of this approach.


METHODS
Electronic searches were performed using the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and SIGLE until September 2002. Dyspepsia outcomes were dichotomized into cured/improved versus same/worse. Results were incorporated into a Markov model comparing health service costs and benefits of PPI with antacid therapy over 1 year.


RESULTS
Eight trials were identified that compared PPI therapy with placebo in 3293 patients. The relative risk of remaining dyspeptic with PPI therapy versus placebo was .86 (95% confidence interval, .78-.95; P = .003, random-effects model) with a number needed to treat of 9 (95% confidence interval, 5-25). There was statistically significant heterogeneity between trials (heterogeneity chi(2) = 30.05; df = 7; P < .001). The PPI strategy would cost an extra US dollar 278/month free from dyspepsia if the drug cost US dollar 90/month. If a generic price of US dollar 19.99 is used, then a PPI strategy costs an extra US dollar 57/month free from dyspepsia. A third-party payer would be 95% certain that PPI therapy would be cost-effective, provided they were willing to pay US dollar 94/month free from dyspepsia.


CONCLUSIONS
PPI therapy may be a cost-effective therapy in nonulcer dyspepsia, provided generic prices are used.
Moayyedi
Paul
P
Gastroenterology Division, McMaster University, Hamilton, Ontario, Canada. moayyep@mcmaster.ca
Delaney
Brendan C
BC
Vakil
Nimish
N
Forman
David
D
Talley
Nicholas J
NJ
D002986:Clinical Trials as Topic; D003365:Costs and Cost Analysis; D004415:Dyspepsia / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D010919:Placebos; D011336:Probability; D054328:Proton Pump Inhibitors
D010919:Placebos; D054328:Proton Pump Inhibitors