A second-order simulation model of the cost-effectiveness of managing dyspepsia in the United States.
BACKGROUND
The "gold-standard'' evidence of effectiveness for a clinical practice guideline is the randomized controlled trial (RCT), although RCTs have a limited ability to explore potential management strategies for a chronic disease where these interact over time. Modeling can be used to fill this gap, and models have become increasingly complex, with both dynamic sampling and representation of second-order uncertainty to provide more precise estimates. However, both simulation modeling and probabilistic sensitivity analysis are rarely used together. The objective of this study was to explore uncertainty in controversial areas of the 2005 American Gastroenterology Association position statement on the management of dyspepsia.


METHODS
Individual sampling model, incorporating a second-order probabilistic sensitivity analysis.


METHODS
US adult patients presenting in primary care with dyspepsia. Interventions compared: empirical acid suppression, test and treat for Helicobacter pylori, initial endoscopy, acid suppression then endoscopy, test and treat then proton pump inhibitor (PPI) then endoscopy.


RESULTS
Cost-effectiveness, quality-adjusted life years, and costs in US dollars from a societal perspective, measured over a 5-year period.


METHODS
mainly Cochrane meta-analyses.


RESULTS
Endoscopy was dominated at all ages by other strategies. PPI therapy was the most cost-effective strategy in 30-year-olds with a low prevalence of H. pylori. In 60-year-olds, H. pylori test and treat was the most cost-effective option.


CONCLUSIONS
Acid suppression alone was more cost-effective than either endoscopy or H. pylori test and treat in younger dyspepsia patients with a low prevalence of infection.
Health Economics Facility, University of Birmingham, UK.
Pelham M
PM
Barton
Paul
P
Moayyedi
Nicholas J
NJ
Talley
Nimish B
NB
Vakil
Brendan C
BC
Delaney
D000328:Adult; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000188:drug therapy* / Q000191:economics; D005382:Financing, Personal; D016480:Helicobacter pylori / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care; D019057:Quality-Adjusted Life Years; D012494:Sampling Studies; D014481:United States