CLINICAL ECONOMICS REVIEW - FUNCTIONAL (NONULCER) DYSPEPSIA

Dyspepsia is common within the general population and it imposes a sig nificant burden on health-care resources, Calculation of the economic implications of functional dyspepsia is constrained by the fact that i t is only possible to make this diagnosis in a minority of individuals with the disorder, because many do not seek medical attention and inv estigation is not appropriate for all who do. Studies which attempt to assess the effectiveness or cost-effectiveness of therapy may be furt her constrained by the fact that there is now good evidence that many patients with dyspepsia seek medical attention not so much because of the severity of symptoms, but because they fear that the symptoms sign al the presence of some serious underlying disease, In this situation, effective well-founded reassurance that no serious disease is present is an important outcome of medical intervention and one which should be included in an economic appraisal of dyspepsia management, For obvi ous reasons, it is sensible to compare the cost effectiveness of vario us clinical management strategies applicable in dyspepsia, Decision-tr ee analyses are currently fashionable but suffer from the major defect that there is no theoretical basis from which patient satisfaction wi th treatment options can be assessed, It is suggested that for disorde rs such as functional dyspepsia, which are non-lethal and non-progress ive, recommendations about acceptable clinical management strategies r equire that account be taken of patient satisfaction with the strategi es being reviewed, Cost effectiveness calculations which take no accou nt of this aspect of outcome are of limited relevance to clinical prac tice.