Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trial (MRC-CUBE trial).
OBJECTIVE
To determine the cost effectiveness of Helicobacter pylori "test and treat" compared with empirical acid suppression in the initial management of patients with dyspepsia in primary care.


METHODS
Randomised controlled trial.


METHODS
80 general practices in the United Kingdom.


METHODS
699 patients aged 18-65 who presented to their general practitioner with epigastric pain, heartburn, or both without "alarm symptoms" for malignancy.


METHODS
H pylori 13C urea breath test plus one week of eradication treatment if positive or proton pump inhibitor alone; subsequent management at general practitioner's discretion.


METHODS
Cost effectiveness in cost per quality adjusted life year (QALY) (EQ-5D) and effect on dyspeptic symptoms at one year measured with short form Leeds dyspepsia questionnaire.


RESULTS
343 patients were randomised to testing for H pylori, and 100 were positive. The successful eradication rate was 78%. 356 patients received proton pump inhibitor for 28 days. At 12 months no significant differences existed between the two groups in QALYs, costs, or dyspeptic symptoms. Minor reductions in costly resource use over the year in the test and treat group "paid back" the initial cost of the intervention.


CONCLUSIONS
Test and treat and acid suppression are equally cost effective in the initial management of dyspepsia. Empirical acid suppression is an appropriate initial strategy. As costs are similar overall, general practitioners should discuss with patients at which point to consider H pylori testing.


BACKGROUND
Current Controlled Trials ISRCTN87644265.
Delaney
Brendan C
BC
Primary Care Clinical Sciences, University of Birmingham, Birmingham B15 2TT. b.c.delaney@bham.ac.uk
Qume
Michelle
M
Moayyedi
Paul
P
Logan
Richard F A
RF
Ford
Alexander C
AC
Elliott
Cathy
C
McNulty
Cliodna
C
Wilson
Sue
S
Hobbs
F D Richard
FD
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004415:Dyspepsia / Q000188:drug therapy* / Q000191:economics; D005194:Family Practice / Q000191:economics; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors