COST-EFFECTIVENESS OF SCREENING FOR AND ERADICATION OF HELICOBACTER-PYLORI IN MANAGEMENT OF DYSPEPTIC PATIENTS UNDER 45 YEARS OF AGE

Objective-To assess the cost effectiveness of screening for and eradic ating Helicobacter pylori in patients under 45 years of age presenting with dyspepsia.Design-A decision analytic model composed of a decisio n tree to represent the epidemiology of dyspepsia and a Markov process to model the outcomes of treatment. Patients-Patients under the age o f 45 years presenting to their general practitioner with (peptic type) dyspepsia. Interventions-Conventional empirical treatment with healin g and maintenance doses of cimetidine v eradication treatment solely i n patients with confirmed peptic ulcer; and conventional empirical tre atment for all dyspeptic patients compared with the use of a serology test to identify patients with H pylori, who then receive endoscopy to investigate the presence of peptic ulcer disease and, when disease is found, are given eradication treatment with a breath test to confirm successful eradication. Main outcome measures-Expected cumulative cost s over a period of 10 years. The proportion of time patients spend wit hout a recurrent ulcer. Results-After receiving eradication treatment, patients with confirmed ulcer spend an average of 99% of their time f ree fi om recurrent ulcer disease compared with 95% after treatment wi th cimetidine. Eradication treatment costs less than that with cimetid ine. When the initial cost of identifying appropriate patients to rece ive eradication treatment is added to the analysis, however, these cos t savings take almost eight years to accrue. Conclusions-Enthusiasm fo r introducing testing for and eradication of H pylori for dyspeptic pa tients in general practice should be tempered by an awareness that cos t savings may take many years to realise.