MODELING DIFFERENT APPROACHES TO THE MANAGEMENT OF UPPER GASTROINTESTINAL-DISEASE

A treatment algorithm for the management of upper gastrointestinal (UG I) disease in general practice has been developed by an international group of general practitioners [the International Gastro Primary Care Group (IGPCG)]. When the algorithm was evaluated to consider the overa ll cost per patient, it was shown to offer savings over current practi ce in the UK. Adjustments to the algorithm have been proposed, usually on the basis of variations in the place and timing of Helicobacter py lori testing and eradication, with or without endoscopy. This paper ev aluates the current cost of UGI disease in the UK, the base IGPCG algo rithm and the 5 major alternative scenarios. The original IGPCG algori thm was the least costly option of all those considered, with addition al H. pylori testing for all patients with suspected ulcer being the s econd least expensive option. Routine endoscopies for all patients or for all patients aged more than 45 years were the most expensive scena rios and would require a 16- or 13-fold increase, respectively, in the provision of endoscopy services in the UK. The use of routine endosco py for all patients aged more than 45 years who were presenting with U GI symptoms for the first time was a mid-priced option, but would stil l require a 5-fold increase in the provision of endoscopy services. Th e modelling process highlights the fact that early stratification of p atients into diagnostic and treatment groups, on the basis of history and symptom cluster, is a less costly approach than that of early rout ine endoscopy or H. pylori testing. If H. pylori testing is to be used routinely, then the least costly way is to apply the method to those patients who have symptoms that are more indicative of ulcer disease. All the scenarios considered resulted in lower drug costs than current average UK drug costs per patient per year, and in fewer prescription s and general practitioner surgery visits per patient. There are sever al ways in which the management of UGI disease in the UK could be impr oved with regard to costs and resource utilisation, some of which are presented here. This process emphasises the value of modelling techniq ues to investigate the consequences of different patient management sc enarios.