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Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial

Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial
Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial
BACKGROUND: A policy of withholding endoscopy in Helicobacter pylori sero-negative dyspeptic patients without sinister symptoms saves up to 36% of endoscopies. However, it is unclear whether the net cost of applying this policy outweighs that of conventional management. AIM: To determine the direct (healthcare) and indirect (productivity) costs of applying a strategy of endoscopy versus no endoscopy in H. pylori sero-negative young dyspeptics in the UK. METHOD: The direct and indirect incremental costs for both strategies were calculated amongst 154 H. pylori seronegative subjects randomized to have an endoscopy or no endoscopy before subsequent management by their general practitioners. The cost per patient of each strategy was calculated using reference values in our clinical setting and sensitivity analysis was used to test different scenarios. RESULTS: The total direct cost rose for the endoscopy group (mean Pound Sterling 103, 95% CI 78 to 127) but did not change for the non-endoscopy group (mean Pound Sterling 6, 95% CI -32 to 44). On average, direct (healthcare) costs for patients in the endoscopy group rose by Pound Sterling 96 (95% CI 51 to 142) more than those for non-endoscopy patients. Indirect (productivity) cost fell for the non-endoscopy group (mean -Pound Sterling 40, 95% CI -220 to 140) compared to a rise for the endoscopy group (mean Pound Sterling 180, 95% CI -60 to 420) (difference not significant). The total cost (including direct and indirect costs) fell for the non-endoscopy group (mean -Pound Sterling 34, 95% CI -228 to 160) but rose for the endoscopy group (mean Pound Sterling 283, 95% CI 32 to 533)--an incremental cost of Pound Sterling 317 (95% CI 0 to 634). For all assumptions in the sensitivity analysis, the mean cost in the endoscopy group was at least Pound Sterling 200 higher than in the non-endoscopy group. CONCLUSIONS: It is less expensive to manage H. pylori-negative dyspeptic patients aged under 45 without sinister symptoms by withholding endoscopy.
absenteeism, adolescent, adult, costs and cost analysis, dyspepsia/diagnosis, economics, microbiology, endoscopy, gastrointestinal economics, evaluation studies as topic, female *health care costs, health expenditures, health resources, utilization, helicobacter pylori, isolation & purification, humans male, referral and consultation, sensitivity and specificity
0954-691X
851-856
Asante, M.
7a151c88-7dbc-48aa-8524-83ed97e31eb9
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Mendall, M.
7ef46c94-d890-41ad-a9b0-2d2fdd3a7bd8
Northfield, T.
92830fcc-804f-4e34-872c-4d6f8bc14ca5
Asante, M.
7a151c88-7dbc-48aa-8524-83ed97e31eb9
Lord, J.
fd3b2bf0-9403-466a-8184-9303bdc80a9a
Mendall, M.
7ef46c94-d890-41ad-a9b0-2d2fdd3a7bd8
Northfield, T.
92830fcc-804f-4e34-872c-4d6f8bc14ca5

Asante, M., Lord, J., Mendall, M. and Northfield, T. (1999) Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial. European Journal of Gastroenterology & Hepatology, 11 (8), 851-856. (PMID:10514116)

Record type: Article

Abstract

BACKGROUND: A policy of withholding endoscopy in Helicobacter pylori sero-negative dyspeptic patients without sinister symptoms saves up to 36% of endoscopies. However, it is unclear whether the net cost of applying this policy outweighs that of conventional management. AIM: To determine the direct (healthcare) and indirect (productivity) costs of applying a strategy of endoscopy versus no endoscopy in H. pylori sero-negative young dyspeptics in the UK. METHOD: The direct and indirect incremental costs for both strategies were calculated amongst 154 H. pylori seronegative subjects randomized to have an endoscopy or no endoscopy before subsequent management by their general practitioners. The cost per patient of each strategy was calculated using reference values in our clinical setting and sensitivity analysis was used to test different scenarios. RESULTS: The total direct cost rose for the endoscopy group (mean Pound Sterling 103, 95% CI 78 to 127) but did not change for the non-endoscopy group (mean Pound Sterling 6, 95% CI -32 to 44). On average, direct (healthcare) costs for patients in the endoscopy group rose by Pound Sterling 96 (95% CI 51 to 142) more than those for non-endoscopy patients. Indirect (productivity) cost fell for the non-endoscopy group (mean -Pound Sterling 40, 95% CI -220 to 140) compared to a rise for the endoscopy group (mean Pound Sterling 180, 95% CI -60 to 420) (difference not significant). The total cost (including direct and indirect costs) fell for the non-endoscopy group (mean -Pound Sterling 34, 95% CI -228 to 160) but rose for the endoscopy group (mean Pound Sterling 283, 95% CI 32 to 533)--an incremental cost of Pound Sterling 317 (95% CI 0 to 634). For all assumptions in the sensitivity analysis, the mean cost in the endoscopy group was at least Pound Sterling 200 higher than in the non-endoscopy group. CONCLUSIONS: It is less expensive to manage H. pylori-negative dyspeptic patients aged under 45 without sinister symptoms by withholding endoscopy.

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More information

Published date: August 1999
Keywords: absenteeism, adolescent, adult, costs and cost analysis, dyspepsia/diagnosis, economics, microbiology, endoscopy, gastrointestinal economics, evaluation studies as topic, female *health care costs, health expenditures, health resources, utilization, helicobacter pylori, isolation & purification, humans male, referral and consultation, sensitivity and specificity
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 382164
URI: http://eprints.soton.ac.uk/id/eprint/382164
ISSN: 0954-691X
PURE UUID: b76f253a-269a-4be3-b7aa-00f4d21328bd
ORCID for J. Lord: ORCID iD orcid.org/0000-0003-1086-1624

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Date deposited: 26 Oct 2015 14:08
Last modified: 19 Nov 2019 01:33

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