Diagnostic work-up and management of young patients with ulcer-like dyspepsia: A cost-minimisation study

Abstract

Objective: We initiated a cost-minimisation modelling study to compare the costs of strategies based on initial endoscopy or initial non-invasive tests for the detection of Helicobacter (C13 UBT or serology) from the perspective of the Italian National Health Service. The secondary outcomes were the number of patients undergoing unnecessary Helicobacter pylori (HP) eradication treatment and the number of endoscopic examinations spared.

Methods: The study was based on a decision analysis model referring to patients aged less than 45 years with ulcer-like dyspepsia and no alarming symptoms. The probabilities entered in the model were weighted means from published studies, and the costs were derived from the Italian NHS reimbursement schedule. Sensitivity analyses were conducted over a wide range of probability and cost estimates in order to test the robustness of the model.

Results: Non-invasive tests (such as the preliminary work-up of patients with ulcer-like dyspepsia aged less than 45 years) were cheaper than the use of prompt endoscopy. Among the non-invasive strategies, initial serology led to a small cost saving in comparison with initial C13, but this was offset by an increase in the number of endoscopies and the number of patients unnecessarily undergoing eradication treatment. Finally, the use of CI3 UBT was cheaper than endoscopy in verifying the effect of eradication in HP-positive patients.

Conclusion: The results of this study show that, from the perspective of the Italian NHS, non-invasive testing would lead to cost savings in the work-up of young dyspeptic patients with ulcer-like symptoms.

Key Words:

• endoscopy
• gastroscopy
• costs
• HP
• dyspepsia
• non-ulcer
• breath test