POLICY ANALYSIS OF THE CONVERSION OF HISTAMINE(2) ANTAGONISTS TO OVER-THE-COUNTER USE

OBJECTIVES. The authors assess the costs associated with treatment of dyspepsia with histamine(2) antagonists versus without availability of over-the-counter (OTC). METHODS. A cost analysis was performed using a decision-analysis model. Patients with an initial episode of dyspeps ia were studied. The model includes casts associated with consumption of OTC and prescription and medications for dyspepsia, physician visit s and associated diagnostic testing, time spent for physician visits a nd diagnostic tests, and hospitalization costs. RESULTS. The model is sensitive to the relative cost of histamine(2) antagonists when purcha sed Rx or QTC, as well as to the efficacy of these drugs in relieving dyspeptic symptoms. For patients with nonulcer dyspepsia (the largest group of likely consumers), the model demonstrates a cost savings if t he OTC cost of the medication is slightly less than one third the Rx c ost, Costs are similar whether or not histamine(2) antagonists are ava ilable OTC, If the symptom relief efficacies of histamine(2) antagonis ts are equivalent whether purchased by prescription only or OTC, then the health-care expenditures for a typical patient with dyspepsia are $204 for OTC availability and $203 for Rx-only use, Viewing costs from the perspective of a managed-care organization, expenditures for an e pisode of dyspepsia are $149 regardless of whether or not histamine(2) antagonists are available OTC. Restricting the analysis to patients w ith underlying nonulcer dyspepsia yields similar results, Variation of numerous assumptions and probabilities other than histamine antagonis t cost and efficacy, including costs associated with physician visits and diagnostic tests, and the likelihood of seeking medical care, do n ot substantially affect the results of the model. CONCLUSIONS. Health- care tests associated with initial treatment of dyspepsia are similar regardless of the availability of histamine(2) antagonists OTC. This i s due largely to the similar efficacy of these drugs compared with ant acids and the predicted increase in diagnostic testing that may result if a patient visits a physician after failure to achieve symptom reli ef with OTC use of histamine(2) antagonists.