Cost-effectiveness of a 'score and scope' strategy for the management of dyspepsia.
OBJECTIVE
It is important to identify the best initial work-up in patients with uninvestigated dyspepsia because of its epidemiological and economical relevance. The objective of the study was to assess systematically the effectiveness and cost-effectiveness of invasive and non-invasive strategies for the management of dyspepsia.


METHODS
A decision analysis was performed to compare prompt endoscopy, score and scope, test and scope, test and treat, and empirical antisecretory treatment. Published and local data on the prevalence of different diagnoses, rates of Helicobacter pylori infection, accuracy values of diagnostic tests, and effectiveness of drug treatments were used. The perspective of analysis was that of the public healthcare payer, and only direct costs were included, with a one-year post-therapy time horizon. The main outcome measure was cost per asymptomatic patient, valued in 2003 Euros.


RESULTS
Endoscopy was found to be the most effective strategy for the management of dyspepsia (38.4% asymptomatic patients), followed by test and scope (35.5%), test and treat (35.3%), score and scope (34.7%), and empirical treatment (28.5%). Incremental cost-effectiveness ratios showed that score and scope was the most cost-effective alternative (483.17 Euros per asymptomatic patient), followed by prompt endoscopy (1396.85 Euros). Sensitivity analyses showed variations when varying the values of prevalence of duodenal ulcer, and the values of healing of functional dyspepsia with antisecretory and eradication drugs. There were no changes when varying the prevalence of H. pylori in dyspepsia.


CONCLUSIONS
We would recommend stratifying patients by a score system, referring first to endoscopy those patients at higher risk of organic dyspepsia.
García-Altés
Anna
A
Fundación Instituto de Investigación en Servicios de Salud, 08012 Barcelona, Spain. annagarcia@post.harvard.edu
Rota
Rosa
R
Barenys
Mercè
M
Abad
Agueda
A
Moreno
Victor
V
Pons
Joan M V
JM
Piqué
Josep M
JM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D001944:Breath Tests / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods; D003663:Decision Trees; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004415:Dyspepsia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005773:Gastroscopy / Q000191:economics* / Q000379:methods; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents; D009853:Omeprazole