Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care

Delaney, Brendan; Wilson, Scott B.; Roalfe, Andrea; Roberts, Lesley; Redman, Val; Wearn, Andy; Briggs, Andrew; Hobbs, FD Richard

doi:10.1016/s0140-6736(00)03308-0

Cited by 114 publications

(77 citation statements)

References 17 publications

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“…CEACs can now be found in major medical journals such as BMJ [1][2][3][4][5], New England Journal of Medicine [6,7], Lancet [8], Circulation [9], Chest [10] as well as health economics and health technology assessment journals [11][12][13][14][15][16][17]. Given the widespread dissemination of this technique it is important to ensure that both analysts and potential users of the information understand the nature and interpretation of these curves.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions

2004

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Cost‐effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health‐care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the ‘textbook’ illustration of the CEAC. This ‘textbook’ CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (λ). But this familiar ‘ogive’ shape which makes the ‘textbook’ CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost‐effectiveness plane, where the joint density of incremental costs and effects may ‘straddle’ quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y‐axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in λ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a ‘gallery’ of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals. Copyright © 2004 John Wiley & Sons, Ltd.

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Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions

2004

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“…The best diagnostic test depended on the assumptions used in the model [20]. This is in contrast to the findings in Birmingham (UK) where a study found that initial endoscopy might be most appropriate, but this study was performed in the over 50 age group, which may account for the different conclusion [3]. A test and endoscopy strategy using near patient serology testing found that there was an increase in endoscopy use, but no increase in quality of life or symptom relief although it did result in the diagnosis of more peptic ulcers [4].…”

Section: Discussionmentioning

confidence: 92%

“…Urea breath testing is widely accepted to be the gold standard non-invasive method of determining H. pylori status, other methods such as near patient serology testing having poor sensitivity and specificity [1]. Some advocate test and treat as the most appropriate management strategy [2]while others have suggested that direct referral for endoscopy may be more cost effective [3]or a test and endoscopy strategy where only patients testing positive for H. pylori are endoscoped [4]. With this in mind the H. pylori breath test service was set up in Leicester in 1997.…”

Section: Introductionmentioning

confidence: 99%

Cost Analysis of Breath Test versus Endoscopy for Dyspepsia

Gee

Turner

Sheldon³

et al. 2002

Digestion

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Background: There is currently much debate on the best way to manage dyspepsia in the community and cost effectiveness is often discussed. We aim to perform a cost analysis of a test and treat strategy for Helicobacter pylori versus endoscopy using data based on the breath test service in Leicester. Methods: Retrospective analysis of data acquired over the 1-year period from March 1, 1999, to February 29, 2000, in a university teaching hospital. The main outcome measure was the cost of each management strategy. Results: Referral to the breath test service cost £84.67 per person with dyspepsia (including treatment of positive patients and endoscopy cost of patients endoscoped). If the breath test service had not existed, referral for endoscopy would have cost £98.35 per person. This equates to a cost saving of £8,276 over the year studied for the 605 patients referred. It also resulted in 353 fewer endoscopies being performed. Conclusion: Direct referral to a H. pylori breath test service saves money, avoids an unpleasant test for many people and reduces the endoscopy waiting list.

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“…In populations with intermediate H. pylori prevalence (3060%) cost-effectiveness analyses are equivalent between the 2 strategies; however, the empiric PPI strategy avoids use of antibiotics and the associated risk of antibiotic resistance [Ladabaum et al 2002]. PPIs are also effective in treating patients with investigated functional dyspepsia with a NNT of 14.6 [Delaney et al 2000;Wang et al 2007]. Similarly, a meta-analysis of randomized controlled trials comparing 'test and treat' and empiric PPI strategies found no difference in symptoms or treatment costs at 12 months [Ford et al 2008].…”

Section: Empiric Proton-pump Inhibitorsmentioning

confidence: 99%

Review: Evaluation and management of dyspepsia

Harmon

Peura

2010

Therap Adv Gastroenterol

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Dyspepsia is a common clinical problem seen by both primary care physicians and gastroenterologists. Initial evaluation should focus on the identification and treatment of potential causes of symptoms such as gastroesophageal reflux disease (GERD), peptic ulcer disease, and medication side effects but also on recognizing those at risk for more serious conditions such as gastric cancer. This manuscript discusses the evaluation and management of dyspepsia including the role of proton-pump inhibitors, treatment of Helicobacter pylori, and endoscopy. Finally, treatment of refractory functional dyspepsia is addressed.

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Cost effectiveness of initial endoscopy for dyspepsia in patients over age 50 years: a randomised controlled trial in primary care

Cited by 114 publications

References 17 publications

Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions

Cost‐effectiveness acceptability curves – facts, fallacies and frequently asked questions

Cost Analysis of Breath Test versus Endoscopy for Dyspepsia

Review: Evaluation and management of dyspepsia

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