Cost effectiveness of screening for and eradication of Helicobacter pylori in management of dyspeptic patients under 45 years of age

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Abstract
Objective: To assess the cost effectiveness of screening for and eradicating Helicobacter pylori in patients under 45 years of age presenting with dyspepsia. Design: A decision analytic model composed of a decision tree to represent the epidemiology of dyspepsia and a Markov process to model the outcomes of treatment. Patients: Patients under the age of 45 years presenting to their general practitioner with (peptic type) dyspepsia. Interventions: Conventional empirical treatment with healing and maintenance doses of cimetidine v eradication treatment solely in patients with confirmed peptic ulcer; and conventional empirical treatment for all dyspeptic patients compared with the use of a serology test to identify patients with H pylori, who then receive endoscopy to investigate the presence of peptic ulcer disease and, when disease is found, are given eradication treatment with a breath test to confirm successful eradication. Main outcome measures: Expected cumulative costs over a period of 10 years. The proportion of time patients spend without a recurrent ulcer. Results: After receiving eradication treatment, patients with confirmed ulcer spend an average of 99% of their time free from recurrent ulcer disease compared with 95% after treatment with cimetidine. Eradication treatment costs less than that with cimetidine. When the initial cost of identifying appropriate patients to receive eradication treatment is added to the analysis, however, these cost savings take almost eight years to accrue. Conclusions: Enthusiasm for introducing testing for and eradication of H pylori for dyspeptic patients in general practice should be tempered by an awareness that cost savings may take many years to realise. Patients under the age of 45 years presenting with peptic-type dyspepsia without sinister symp- toms are usually managed empirically Only a minority of these patients will have peptic ulcer disease and Helicobacter pylori infection Identification of appropriate patients for H pylori eradication treatment from among dyspeptic patients will entail a considerable investment of resources Consequently, the cost savings associated with a reduction in use of H2 antagonists by patients who receive successful H pylori eradication may take many years to materialise