Economic evaluation of a randomized trial comparing Helicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting.
BACKGROUND
In western European countries, most dyspeptic patients are initially managed by their general practitioners (GPs), who use a range of strategies to manage dyspepsia. We performed an economic analysis of a Helicobacter pylori test-and-treat strategy versus a prompt endoscopy approach in a primary care setting.


METHODS
Data were used from the Strategy: Endoscopy versus Serology (SENSE) study, performed in The Netherlands from 1998 to 2001. Patients were randomized to a prompt endoscopy (n = 105) or test-and-treat (n = 118) group. Follow-up lasted 1 year. Adverse events were not recorded in the SENSE study. Health care costs were based on the total amount of dyspepsia-related drugs used, the number of dyspepsia-related GP visits, the number of diagnostic tests, and the number of dyspepsia-related referrals to specialists. The use of medical resources was calculated as standardized costs for 1999, recorded as euros. (On December 31, 1999, 1.00 Euro = 1.00 US dollar.) Quality of life was measured at inclusion and 1 year later, using the RAND-36 questionnaire. To calculate quality-adjusted life-years (QALYs), we transformed the individual scores of the RAND-36 into 1 overall score, the Health Utilities Index Mark 2, which introduced a limitation to the study. An incremental cost-effectiveness ratio (ICER) was calculated. The 95% confidence limits were calculated using a parametric bootstrap method with angular transformation. All cost data were analyzed from a third-party payer perspective.


RESULTS
The total costs per patient were 511 Euros, with 0.037 QALY gained per patient, in the test-and-treat group, and 748 Euros, with 0.032 QALY gained per patient, in the endoscopy group (between groups, P < 0.001 and P = NS, respectively). The point estimate of the ICER indicated that the test-and-treat strategy yielded cost savings and QALYs gained. Parametric bootstrap confidence limits indicated cost savings per QALY gained in 75.7% of the bootstrap simulations.


CONCLUSIONS
This analysis of data from the SENSE1026 study suggests that the H pylori test-and-treat strategy was more cost-effective than prompt endoscopy in the initial management of dyspepsia in general practice, from the perspective of a third-party payer.
Klok
Rogier M
RM
Groningen University Institute for Drug Exploration, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, The Netherlands. R.M.Klok@rug.nl
Arents
Nicolaas L A
NL
de Vries
Robin
R
Thijs
Jacob C
JC
Brouwers
Jacobus R B J
JR
Kleibeuker
Jan H
JH
Postma
Maarten J
MJ
D000328:Adult; D000465:Algorithms; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D005260:Female; D005773:Gastroscopy / Q000191:economics; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016032:Randomized Controlled Trials as Topic / Q000191:economics
D000897:Anti-Ulcer Agents