PGI2: ALTERNATIVE MANAGEMENT STRATEGIES FOR DYSPEPSIA

Autor: EQ Wu, Joel W. Hay
Rok vydání: 2001
Předmět:
Zdroj: Value in Health. 4(2):121-122
ISSN: 1098-3015
DOI: 10.1046/j.1524-4733.2001.40202-143.x
Popis: OBJECTIVE: To compare the cost-effectiveness of alternative dyspepsia management strategies: (1) H. pylori testing; if seropositive, providing H. pylori eradication treatment using oral omeprazole, clarithromycin, and amoxicillin; (2) empiric antisecretory therapy using omeprazole. METHODS: Decision analytical models compared cost/QALY for alternative strategies in patients grouped by gender and age. The study was conducted from the societal perspective using Year 1996–1999 prices, adjusted to year 2000 by CPI. Life expectancies were adjusted for QOL using the Index of Well-Being. Probabilities and prices were collected from the literature, the SEER program, National Vital Statistics, and BLS. The model considered H. pylori reinfection and gastric carcinogenesis risk over time. One-way sensitivity analyses were conducted on critical or uncertain parameters and threshold analyses on pivotal parameters. RESULTS: The incremental cost-effectiveness ratio (ICE) for pooled patients (both genders) decreases with age from $3,612 per quality adjusted life year (QALY) saved at age 40–44 to the minimum of −$200 (dominant) per QALY saved at age 65–70. After age 70, the ICE increases with age. Females have higher ICEs than males in every age subgroup. The ICE was sensitive to discount rate, relative risk of gastric cancer (GC) in H. pylori infected patients, cost of treating GC, and cost of empiric antisecretory therapy, but not to the reinfection rate or infection rate of H. pylori, the change of the utility rate of GC and the one-year utility of dyspepsia patient under empiric antisecretory therapy. CONCLUSIONS: Taking $50,000/QALY as the societal ICE threshold, H. pylori screening and eradication is cost-effective for both genders at any age group, especially for male patients at older ages. Better estimates are needed for certain key parameters such as the relative risk reduction of GC with H. pylori eradication.
Databáze: OpenAIRE
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