Endoscopy for Helicobacter pylori sero-negative young dyspeptic patients: an economic evaluation based on a randomized trial

Background A policy of withholding endoscopy in Helicobacter pylori sere-ne gative dyspeptic patients without sinister symptoms saves up to 36% of endo scopies. However, it is unclear whether the net cost of applying this polic y outweighs that of conventional management. Aim To determine the direct (healthcare) and indirect (productivity) costs of applying a strategy of endoscopy versus no endoscopy in H. pylori sere-n egative young dyspeptics in the UK. Method The direct and indirect incremental costs for both strategies were c alculated amongst 154 H. pylori seronegative subjects randomized to have an endoscopy or no endoscopy before subsequent management by their general pr actitioners. The cost per patient of each strategy was calculated using ref erence values in our clinical setting and sensitivity analysis was used to test different scenarios, Results The total direct cost rose for the endoscopy group (mean pound 103, 95% CI 78 to 127) but did not change for the non-endoscopy group (mean pou nd 6, 95% CI -32 to 44), On average, direct (healthcare) costs for patients in the endoscopy group rose by pound 96 (95% CI 51 to 142) more than those for non-endoscopy patients. Indirect (productivity) cost fell for the non- endoscopy group (mean -pound 40, 95% CI - 220 to 140) compared to a rise fo r the endoscopy group (mean pound 180, 95% CI -60 to 420) (difference not s ignificant). The total cost (including direct and indirect costs) fell for the non-endoscopy group (mean -pound 34, 95% CI -228 to 160) but rose for t he endoscopy group (mean pound 283, 95% CI 32 to 533) - an incremental cost of pound 317 (95% CI 0 to 634), For all assumptions in the sensitivity ana lysis, the mean cost in the endoscopy group was at least pound 200 higher t han in the non-endoscopy group. Conclusions It is less expensive to manage H. pylori-negative dyspeptic pat ients aged under 45 without sinister symptoms by withholding endoscopy, Eur J Gastroenterol Hepatol 11:851 -856 (C) 1999 Lippincott Williams & Wilkins .