A team from the University of Birmingham Medical School, England, determined the cost-effectiveness of a strategy of near patient Helicobacter pylori testing and endoscopy for managing dyspepsia.
478 patients, under 50 years old, presenting with dyspepsia of longer than four weeks' duration, at 31 UK primary care centers were enrolled in the study.
Near patient testing for H. pylori and open access endoscopy for patients with positive results were performed.
Costs per patient:|
Study group: £368
Control group: £253
|British Medical Journal|
Control patients received acid-suppressing drugs or specialist referral at the general practitioner's discretion.
The main outcome measures were cost-effectiveness based on improvement in symptoms and use of resources at 12 months, and quality of life.
The researchers found that 40% of the study group tested positive for H. pylori.
45% of study patients had endoscopy, compared with 25% of controls.
More peptic ulcers were diagnosed in the study group (7.4% vs. 2.1%).
Paired comparison of symptom scores and quality of life showed that all patients improved over time, with no difference between study and control groups. In addition, no significant differences were observed in rates of prescribing, consultation, or referral.
Costs were found to be higher in the study group (£368 vs. £253 per patient).
Dr B C Delaney, a Senior Lecturer at the University, concluded on behalf of the group, "The test and endoscopy strategy increases endoscopy rates over usual practice in primary care.
"The additional cost is not offset by benefits in symptom relief or quality of life, and cannot be justified."