Economic evaluation of a randomized trial comparing Helicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting

• Published in: Clinical therapeutics 2005-10, Vol.27 (10), p.1647-1657
• Main Authors: Klok, Rogier M, Arents, Nicolaas L A, de Vries, Robin, Thijs, Jacob C, Brouwers, Jacobus R B J, Kleibeuker, Jan H, Postma, Maarten J
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Anti-Ulcer Agents - economics; Anti-Ulcer Agents - therapeutic use; Cost-Benefit Analysis; Dyspepsia - diagnosis; Dyspepsia - economics; Dyspepsia - therapy; Female; Gastroscopy - economics; Helicobacter Infections - diagnosis; Helicobacter Infections - economics; Helicobacter Infections - therapy; Helicobacter pylori - isolation & purification; Humans; Male; Middle Aged; Netherlands; Randomized Controlled Trials as Topic - economics
• ISSN: 0149-2918
• DOI: 10.1016/j.clinthera.2005.10.011

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. 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. 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. 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.