Cost-effectiveness of a 'score and scope' strategy for the management of dyspepsia

European Journal of Gastroenterology and Hepatology

Volumn 17, Issue 7, 2005, Pages 709-719

  García Altés, Anna ^a,b,c   Rota, Rosa ^d   Barenys, Mercè ^d   Abad, Águeda ^d   Moreno, Victor ^e   Pons, Joan M V ^b   Piqué, Josep M ^f  

^a Fundacion Instituto de Investigacion en Servicios de Salud   (Spain)

^b Catalan Agency for Health Technology Assessment and Research   (Spain)

^c UNIVERSITAT AUTÒNOMA DE BARCELONA   (Spain)

^d HOSPITAL DE VILADECANS   (Spain)

^e CATALAN INSTITUTE OF ONCOLOGY   (Spain)

^f HOSPITAL CLÍNIC   (Spain)

Author keywords

Cost effectiveness; Decision analysis; Dyspepsia; Score and scope

Indexed keywords

AMOXICILLIN; CLARITHROMYCIN; OMEPRAZOLE; STOMACH SECRETION INHIBITOR;

ARTICLE; COST EFFECTIVENESS ANALYSIS; DECISION MAKING; DIAGNOSTIC ACCURACY; DUODENUM ULCER; DYSPEPSIA; ERADICATION THERAPY; GASTROINTESTINAL ENDOSCOPY; HELICOBACTER INFECTION; HELICOBACTER PYLORI; HUMAN; OUTCOMES RESEARCH; PREVALENCE; PRIORITY JOURNAL; PUBLIC HEALTH SERVICE; SENSITIVITY ANALYSIS; STOMACH ULCER; TREATMENT OUTCOME; UREA BREATH TEST;

ANTI-BACTERIAL AGENTS; ANTI-ULCER AGENTS; BREATH TESTS; COST-BENEFIT ANALYSIS; DECISION TREES; DIAGNOSTIC TESTS, ROUTINE; DUODENAL ULCER; DYSPEPSIA; GASTROSCOPY; HELICOBACTER INFECTIONS; HELICOBACTER PYLORI; HUMANS; MIDDLE AGED; OMEPRAZOLE; STOMACH ULCER;

EID: 21244497784     PISSN: 0954691X     EISSN: None     Source Type: Journal    
DOI: 10.1097/00042737-200507000-00004     Document Type: Article

References (88)

1. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. US Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38:1569-1580.
2. Collin Jones DG, Bloom B, Bodemar G, Crean G, Freston J, Gugler R, et al. Management of dyspepsia: report of a working party. Lancet 1988; i:576-579.
3. Talley NJ, Stanghellini V, Heading RC, Kock KL, Malagelada JR, Tytgat GNF. Functional gastrointestinal disorders. Gut 1999; 45 (suppl 2):II37-II42.
4. Moayyedi P, Mason J. Clinical and economic consequences of dyspepsia in the community. Gut 2002; 50 (suppl 4):iv10-iv12.
5. American College of Physicians. Endoscopy in the evaluation of dyspepsia. Ann Intern Med 1985; 102:226-229.
6. Delaney BC, Innes MA, Deeks J, Wilson S, Oakes R, Moayyedi P, et al. Initial management strategies for dyspepsia. Cochrane Database Syst Rev 2000; 2:CD001961.
7. Delaney BC. Why do dyspeptic patients over the age of 50 consult their general practitioner? A qualitative investigation of health beliefs relating to dyspepsia. Br J Gen Pract 1998; 48:1481-1485.
8. Laheij RJ, Severens JL, Jansen JB, van de Lisdonk EH, Verbeek AL. Management in general practice of patients with persistent dyspepsia. A decision analysis. J Clin Gastroenterol 1997; 25:563-567.
9. Laheij RJ, Severens JL, van de Lisdonk EH, Verbeek AL, Jansen JB. Randomised controlled trial of omeprazole or endoscopy in patients with persistent dyspepsia; a cost-effective analysis. Aliment Pharmacol Ther 1998; 12:1249-1256.
10. Moayyedi P, Soo S, Deeks J, Delaney B, Harris A, Innes M, et al. Eradication of Helicobacter pylori for non-ulcer dyspepsia (Cochrane Review). Cochrane Database Syst Rev 2001; 1:CD002096.
11. Manes G, Menchise A, de Nucci C, Balzano A. Empirical prescribing for dyspepsia: randomised controlled trial of test and treat versus omeprazole treatment. BMJ 2003; 326:1118-1121.
12. Patel P, Khulusi S, Mendall MA, Lloyd R, Jazrawwi R, Maxweel JD, et al. Prospective screening of dyspeptic patients by Helicobacter pylori serology. Lancet 1995; 346:1315-1318.
13. Mendall MA, Jazrawi RP, Marrero JM, Molineaux N, Levi J, Maxwell JD, et al. Serology for Helicobacter pylori compared with symptom questionnaires in screening before direct access endoscopy. Gut 1995; 36:330-333.
14. Heaney A, Collins JS, Watson RG, McFarland RJ, Bamford KB, Tham TC. A prospective randomised trial of a "test and treat" policy versus endoscopy based management in young Helicobacter pylori positive patients with ulcer-like dyspepsia, referred to a hospital clinic. Gut 1999; 45: 186-190.
15. Formoso G, Maestri E, Magrini N, Koch M, Capurso L, Liberati A. Eradicating Helicobacter pylori in non-ulcer dyspepsia may not be cost effective [Letter]. BMJ 2001; 322:557.
16. Slum AL, Talley NJ, O'Morain C, van Zanten SV, Labenz J, Stolte M, et al. Lack of effect of treating Helicobacter pylori infection in patients with nonulcer dyspepsia. Omeprazole plus Clarithromyctn and Amoxicillin Effect One Year after Treatment (OCAY) Study Group. N Engl J Med 1998; 339:1875-1881.
17. Moayyedi P, Soo S, Deeks J, Forman D, Mason J, Innes M, et al. Systematic review and economic evaluation of Helicobacter pylori eradication treatment for non-ulcer dyspepsia. Dyspepsia Review Group. BMJ 2000; 321:659-664.
18. Gillen D, Wirz AA, Ardill JE, McColl KE. Rebound hypersecretion after omeprazole and its relation to on-treatment acid suppression and Helicobacter pylori status. Gastroenterology 1999; 116:239-247.
19. Spiegel BMR, Vakil NB, Ofman JJ. Dyspepsia management in primary care: a decision analysis of competing strategies. Gastroenterology 2002; 122:1270-1285.
20. Dooley CP, Larson AW, Stace NH, Renner IG, Valenzuela JE, Eliasoph J, et al. Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med 1984; 101:538-545.
21. Bytzer P, Hansen J. Empirical H2-blocker therapy or prompt endoscopy in management of dyspepsia. Lancet 1994; 343:811-816.
22. Delaney BC, Wilson S, Roalfe A, Roberts L, Redman V, Wearn A, et al. Cost-effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care. Lancet 2000; 356:1965-1969.
23. Delaney BC, Wilson S, Roalfe A, Roberts L, Redman V, Wearn A, et al. Randomised controlled trial of Helicobacter pylori testing and endoscopy for dyspepsia in primary care. BMJ 2001; 322:898-901.
24. Barenys M, Abad A, Pons JMV, Moreno V, Rota R, Granados A, et al. Scoring system has better discriminative value than Helicobacter pylori testing in patients with dyspepsia in a setting with high prevalence of infection. Eur J Gastroenterol Hepatol 2000; 12:1275-1282.
25. Davenport PM, Morgan AG, Darnborough A. Can preliminary screening of dyspeptic patients allow more effective use of investigational techniques? BMJ 1985; 290:217-219.
26. Holdstock G, Harman M, Machin D, Patel C, Lloyd RS. Prospective testing of a scoring system designed to improve case selection for upper gastrointestinal investigation. Gastroenterology 1986; 90:1164-1169.
27. Kiill J, Anderson D. X-ray examination and or endoscopy in the diagnosis of gastroduodenal ulcer and cancer. Scand J Gastroenterol 1979; 15:39-43.
28. Mollman KM, Bonnevie O, Gudbrand-Hayer E. A diagnostic study in patients with upper abdominal pain. Scand J Gastroenterol 1975; 10: 105-109.
29. Johnsen R, Bernersen B, Straume B, Forde OH, Bostad L, Burhol PG. Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. BMJ 1991; 302:749-752.
30. Bytzer P, Schaffalitzky de Muckadell OB. Prediction of major pathologic conditions in dyspeptic patients referred for endoscopy. A prospective evaluation of a scoring system. Scand J Gastroenterol 1992; 27: 987-992.
31. Bianchi Porro G, Parente F, Imbesi V, Montrone F, Caruso L. Role of Helicobacter pylori in ulcer healing and recurrence of gastric and duodenal ulcers in longterm NSAID users. Response to omeprazole dual therapy. Gut 1996; 39:22-26.
32. Lassen AT, Pedersen FM, Bytzer P, Shaffalitzky de Muckadell OB. Helicobacter pylori test and eradicate versus prompt endoscopy for management of dyspeptic patients: a randomised trial. Lancet 2000; 356:455-460.
33. Capurso L, Koch M, Dezi A, Koch G, di Ciocco U. Towards a quantitative diagnosis of dyspepsia: the value of clinical symptoms. Ital J Gastroenterol 1988; 20:191-202.
34. Pilotto A, Franceschi M, Concetta Costa M, Mario FD, Valerio G. Helicobacter pylori test and eradication strategy. Lancet 2000; 356: 1683-1684.
35. Van der Hulst RWM, Raws EAJ, Köycu B, Keller JJ, Bruno MJ, Tijssen JGP, et al. Prevention of ulcer recurrence after eradication of Helicobacter pylori: a prospective long-term follow-up study. Gastroenterology 1997; 113:1082-1086.
36. Sung JJ, Chung SC, Ling TK, Yung MY, Leung VK, Ng EK, et al. Antibacterial treatment of gastric ulcers associated with Helicobacter pylori. N Engl J Med 1995; 332:139-142.
37. Bermejo F, Boixeda D, Gisbert JP, Defarges V, Martin de Argila C, Sanz JM, et al. Effects of Helicobacter pylori eradication on the recurrence of gastric ulcer during a 12-month follow up [in Spanish]. Med Clin (Barc) 2000; 115:201-204.
38. Hopkins RJ, Giraldi LS, Turney EA. Relationship between Helicobacter pylori eradication and duodenal and gastric ulcer recurrence: a review. Gastroenterology 1996; 110:1244-1252.
39. Van der Hulst RW, Tytgat GN. Helicobacter pylori and peptic ulcer disease. Scand J Gastroenterol Suppl 1996; 220:10-18.
40. Silverstein MD, Petterson T, Talley NJ. Initial endoscopy or empirical therapy with or without testing for Helicobacter pylori for dyspepsia: a decision analysis. Gastroenterology 1996; 110:72-83.
41. Marshall BJ. Helicobacter pylori. Am J Gastroenterol 1994; 89 (8 suppl):S116-S128.
42. Gene E, Calvet X, Azagra R. Diagnosis of Helicobacter pylori after triple therapy in uncomplicated duodenal ulcers - a cost-effectiveness analysis. Aliment Pharmacol Ther 2000; 14:433-442.
43. Gisbert JP, Mur M, Boixeda D, Cena G, Martin de Argila C, Alvarez Baleriola I, et al. One-week treatment with omeprazole, clarithromycin and amoxicillin: high efficacy in the eradication of Helicobacter pylori and cicatrization of duodenal ulcer [in Spanish]. Med Clin (Barc) 1997; 108:524-529.
44. O'Brien B, Goeree R, Mohamed AH, Hunt R. Cost-effectiveness of Helicobacter pylori eradication for the long term management of duodenal ulcer in Canada. Arch Intern Med 1995; 155:1958-1964.
45. Sontag SJ, Hirschowitz BI, Holt S, Robinson MG, Behar J, Malcolm M, et al. Two doses of omeprazole versus placebo in symptomatic erosive esophagitis: the US multicenter study. Gastroenterology 1992; 102: 109-118.
46. Tytgat G, Hungin APS, Malfertheiner P, Talley N, Hongo M, Mc Coll K, et al. Decision-making dyspepsia in primary and secondary care. Eur J Gastroenterol Hepatol 1999; 11:223-229.
47. McColl K, Murray L, el-Omar E, Dickson A, el-Nujumi A, Wirz A, et al. Symptomatic benefit from eradicating Helicobacter pylori in patients with non ulcer dyspepsia. N Engl J Med 1998; 339:1869-1874.
48. Blum AL, Arnold R, Stolte M, Fischer M, Koetz HR. Short-course acid suppression treatment for patients with functional dyspepsia: results depend on Helicobacter pylori status. Gut 2000; 47:473-480.
49. Talley NJ, Meineche-Schmidt V, Pare P, Duckworth M, Raisanen P, Pap A, et al. Efficacy of omeprazole in functional dyspepsia: double-blind, randomized, placebo-controlled trials (the Bond and Opera studies). Aliment Pharmacol Ther 1998; 12:1055-1065.
50. Adshek K, Sanger J, Longmire WP. Cancer of the stomach: review of consecutive ten year intervals. Ann Surg 1978; 189:6-9.
51. Barenys M, Rota R, Moreno V, Villafafila R, Garcia-Bayo I, Abad A, et al. Prospective validation of a clinical scoring system for the diagnosis of organic dyspepsia [in Spanish]. Med Clin (Barc) 2003; 121:766-771.
52. Gisbert JP, Cruzado LM, Benito D, Perez-Poveda L, Gonzalez A, de Pedro M, et al. The test and treat strategy in dyspeptic patients. Is it useful? [in Spanish]. Gastroenterol Hepatol 2001; 24:66.
53. Talley NJ, Janssens J, Lauritsen K, Racz I, Bolling-Sternevald E. Eradication of Helicobacter pylori in functional dyspepsia: randomised double-blind placebo controlled trial with 12 months of follow-up. The Optimal Regimen Cures Helicobacter Induced Dyspepsia (ORCHID) Study Group. BMJ 1999; 318:833-837.
54. Talley NJ, Vakil N, Ballard ED, Fennerty MB. Absence of benefit of eradicating Helicobacter pylori in patients with nonulcer dyspepsia. N Engl J Med 1999; 341:1106-1111.
55. Imperiale TF, Speroff T, Cebul RD, Mc Cullough AJ. A cost analysis of alternative treatments for duodenal ulcer. Ann Intern Med 1995; 123: 665-672.
56. Logan RP. Urea breath tests in the management of Helicobacter pylori infections. Gut 1998; 43 (suppl 1);S47-S50.
57. Scottish Intercollegiate Guidelines Network. Helicobacter pylori. Eradication in dyspeptic disease. Edinburgh, Scotland: SIGN; August 1996.
58. Thijs JC, van Zwet AA, Thijs WJ, Oey HB, Karrenbeld A, Stellaard F, et al. Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol 1996; 91:2125-2129.
59. 13C-urea breath test in the detection of Helicobacter pylori and in monitoring the effect of tripotassium dicitrato bismuthate in non-ulcer dyspepsia. Gut 1990; 31:1237-1241.
60. Veldhuyzen van Zanten SJO. A systematic overview (meta-analysis) of outcome measures in Helicobacter pylori gastritis trials and functional dyspepsia. Scand J Gastroenterol 1993; 28 (suppl) 199:40-43.
61. García-Altés A, Jovell AJ, Serra-Prat M, Aymerich M. Management of Helicobacter pylori in duodenal ulcer: a cost-effectiveness analysis. Aliment Pharmacol Ther 2000; 14:1631-1638.
62. Marshall BJ, Plankey MW, Hoffman SR, Boyd CL, Dye KR, Frierson HF, et al. A 20 minutes breath test for Helicobacter pylori. Am J Gastroenterol 1991; 86:438-445.
63. Henze E, Malfertheiner P, Clausen M, Burkhardt H, Adam WE. Validation of a simplified carbon-14-urea breath test for routine use for detecting Helicobacter pylori noninvasively. J Nucl Med 1990; 31:1940-1944.
64. Thillainayagam AV, Arvind AS, Cook RS, Harrison IG, Tabaqchali S, Farthing MJ. Diagnostic efficiency of an ultrarapid endoscopy room test for Helicobacter pylori. Gut 1991; 32:467-469.
65. a Edición. Madrid: Medicom, S.A.; 2001.
66. Catáleg de prestacions de suport diagnóstic i terapéutic de l'ICS: Gabinets d'atenció especialitzada ambulatoria. 2a edición. Barcelona: Institut Català de la Salut; 2001.
67. Borda F, Echarri A, Martinez A, Elizalde I, Jiménez J, Rodríguez C. Economic study up to a year of two strategies in front of a patient with ulcer clinical symptoms [in Spanish]. Rev Esp Enf Digest 1997; 87 (suppl):43.
68. Martínez-Sánchez G, Saperas E, Benavent J, Mearin F, Piñol JL, Barenys M, et al. Practices of primary care doctors of Barcelona in front of the diagnostic and treatment of Helicobacter pylori infection in gastroduodenal diseases [in Spanish]. Gastroenterología y Hepatología 1998; 21:473-478.
69. Ebell MH, Warbasse L, Brenner C. Evaluation of the dyspeptic patient: a cost-utility study. J Family Pract 1997; 44:545-555.
70. Fendrick AM, Chernew ME, Hirth RA, Bloom BS. Alternative management strategies for patients with suspected peptic ulcer disease. Ann Intern Med 1995; 123:260-268.
71. Moayyedi P, Zilles A, Clough M, Heminbrough E, Chalmers DM, Axon AT. The effectiveness of screening and treating Helicobacter pylori in the management of dyspepsia. Eur J Gastroenterol Hepatol 1999; 11:1245-1250.
72. Delaney B, Moayyedi P, Deeks J, Innes M, Soo S, Barton P, et al. The management of dyspepsia: a systematic review. Health Technol Assess 2000; 4;iii-v: 1-189.
73. Ladabaum U, Chey WD, Scheiman JM, Fendrick AM. Reappraisal of non-invasive management strategies for uninvestigated dyspepsia: a cost-minimization a nalysis. Aliment Pharmacol Ther 2002; 16:1491-1501.
74. Gillen D, Mc Coll KE. Does concern about missing malignancy justify endoscopy in uncomplicated dyspepsia in patients aged less than 55 years? Am J Gastroenterol 1999; 94:75-79.
75. Fransen AJ, Fransen GA, Janssen MJ, Muris JW, Laheij RJ, Jansen JB. Meta-analysis: the diagnostic value of alarm symptoms for upper gastrointestinal malignancy. Aliment Pharmacol Ther 2004; 20:1045-1052.
76. Uemara N, Okamoto S, Yamamoto, Matsamura N, Yamaguchi S, Yamakido M, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med 2001; 345:784-789.
77. Boixeda D, Gisbert JP, Martin de Argua C, Cantón R, Bermejo F, García Plaza A. Is there any relationship between digestive symptomatology and Helicobacter pylori infection? [in Spanish]. Rev Esp Enferm Dig 1995; 87:8-14.
78. Smith T, Verzola E, Mertz H. Low yield of endoscopy in patients with persistent dyspepsia taking proton pump inhibitors. Gastrointest Endosc 2003; 58:9-13.
79. Xia HH, Phung N, Aliparamark E, Berry A, Matheson M, Talley NJ. Reduction of peptic ulcer disease and Helicobacter pylori infection but increase of reflux esophagitis in Western Sydney between 1990 and 1998. Dig Dis Sci 2001; 46:2716-2723.
80. Groeneveld PW, Lieu TA, Fendrick AM, Hurley LB, Ackerson LM, Levin TR, Allison JE. Quality of life measurement clarifies the cost-effectiveness of Helicobacter pylori eradication in peptic ulcer disease and uninvestigated dyspepsia. Am J Gastroenterol 2001; 96:338-347.
81. Severens JL, Laheij RJ, Jansen JB, Van der Lisdonk EH, Verbeek AL. Estimating the cost of lost productivity in dyspepsia. Aliment Pharmacol Ther 1998; 12:919-923.
82. Finkler SA. The distinction between cost and charges. Ann Intern Med 1982; 96:102-109.
83. Talley NJ. Dyspepsia management in the millennium: the death of test and treat? Gastroenterology 2002; 122:1521-1525.
84. García-Altés A, Jovell AJ, Aymerich M, Serra-Prat M. Thinking globally, analysing locally: cross national comparison of the efficiency of duodenal ulcer treatment. In: 16th Annual Meeting of the International Society of Technology Assessment in Health Care (ISTAHC). The Hague, June 2000.
85. Groenveld PW, Lieu TA, Fendrick AM, Hurley LB, Ackerson LM, Levin TR, et al. Quality of life measurement clarifies the cost-effectiveness of Helicobacter pylori eradication in peptic ulcer disease and uninvestigated dyspepsia. Am J Gastroenterol 2001; 96:338-347.
86. Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-effectiveness in health care and medicine. New York: Oxford University Press; 1996.
87. Veldhuyzen van Zanten SJ. Assessment of outcome in dyspepsia: has progress been made? Gut 2002; 50 (suppl 4):v23-v25.
88. Meinecke-Schmidt V, Rubin G, de Wit NJ. Helicobacter pylori infection: a comparative review of existing management guidelines. Family Pract 2000; 17 (suppl 2):S2-S5.