Researchers from the Universities of Birmingham and Oxford, England, determined the cost-effectiveness of initial endoscopy compared with usual management in patients with dyspepsia.
422 patients, all over 50 years of age, were recruited and randomly assigned to initial endoscopy or usual management.
Initial endoscopy improves symptoms, decreases pain, and lowers PPI use
The primary outcomes assessed were: effect of treatment on dyspepsia symptoms and cost-effectiveness. Secondary outcomes were quality of life and patient satisfaction.
Total costs were calculated from individual patient's use of resources, with unit costs applied from national data. Statistical analysis of uncertainty on incremental cost-effectiveness ratio (ICER) was done, along with a sensitivity analysis on unit costs with cost-effectiveness acceptability curves.
In the 12 months following recruitment, 84 per cent of patients had an endoscopy, compared with 41 per cent of controls.
The team found that initial endoscopy resulted in a significant improvement in symptom score, quality of life (pain dimension), and a 48 per cent reduction in the use of proton pump inhibitors.
The ICER was £1728 (UK£) per patient symptom-free at 12 months. The researchers found that the ICER was very sensitive to the cost of endoscopy, and could be reduced to £165 if the unit cost of this procedure fell from £246 to £100 (£1 = US$1.44).
Dr Brendan Delaney concluded from the group's research that, "Initial endoscopy in dyspeptic patients over age 50 might be a cost-effective intervention."