Economic evaluation of empirical antisecretory therapy versusHelicobacter pylorifor management of dyspepsia: A randomized trial in primary care

Abstract

Objectives:An economic evaluation was performed of empirical antisecretory therapy versus test forHelicobacter pyloriin the management of dyspepsia patients presenting in primary care.Methods:A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n=722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing forHelicobacter pylori, or (iii) empirical antisecretory therapy, followed byHelicobacter pyloritesting if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined.Results:The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in theH. pyloritest-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment,H. pyloritest and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment orH. pyloritest alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms.Conclusions:Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test forH. pyloriand is probably not a cost-effective strategy for the management of dyspepsia in primary care.