The evidence that proton pump inhibitor (PPI) therapy affects symptoms of nonulcer dyspepsia is conflicting.
Researchers from America and England, lead by Dr Paul Moayyedi, conducted a systematic review to evaluate whether PPI therapy had any effect in nonulcer dyspepsia.
The investigators also constructed a health economic model to assess the cost-effectiveness of this approach.
The research group performed electronic searches using the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and SIGLE until September 2002.
The researchers grouped dyspepsia outcomes into cured/improved versus same/worse.
|Relative risk of remaining dyspeptic with PPI therapy versus placebo was 86|
The research group incorporated the results into a Markov model comparing health service costs and benefits of PPI with antacid therapy over 1 year.
The group identified 8 trials in total that compared PPI therapy with placebo in 3293 patients.
The researchers found that the relative risk of remaining dyspeptic with PPI therapy versus placebo was 86, with a number needed to treat of 9.
There was statistically significant heterogeneity between trials.
The research group noted that the PPI strategy would cost an extra $278/month free from dyspepsia if the drug cost $90/month.
If a generic price of $19.99 is used, then a PPI strategy costs an extra $57/month free from dyspepsia.
Dr Moayyedi conmmented, "A third-party payer would be 95% certain that PPI therapy would be cost-effective, provided they were willing to pay $94/month free from dyspepsia."
He concluded, "PPI therapy may be a cost-effective therapy in nonulcer dyspepsia, provided generic prices are used."