Management of acid-related dyspepsia in general practice - Cost-effectiveness analysis comparing an omeprazole vs an antacid-alginate/ranitidine management strategy

Objective: The objective of this study was to assess the relative cost effe ctiveness of an omeprazole strategy versus an antacid-alginate/ranitidine s trategy for the management of acid-related dyspepsia in general practice fr om a third-party payer perspective. Patients and Methods: A retrospective economic assessment of direct medical costs of treatment was performed on data from a prospective, open-label, r andomised, parallel-group, 16-week clinical trial. 725 patients with a mini mum 1-month history of dyspepsia were randomised to receive either omeprazo le 10mg once every morning, increasing to 20mg once every morning and 40mg once every morning as required, or antacid-alginate 10ml four times daily, with the addition of ranitidine 150mg twice daily and 150mg four times dail y as required, for 16 weeks. Results: A greater proportion of patients receiving the omeprazole clinical management strategy had achieved the stringent health target of complete s ymptom relief (61 vs 40%, p < 0.0001) at 16 wee ks. Sufficient symptom reli ef at 16 weeks was achieved by 70% of the omeprazole treatment group compar ed with 51% of the antacid-alginate/ranitidine group (p < 0.0001). In the o meprazole clinical management strategy arm, the average medication cost per patient was higher (pound 99 vs pound 65), whilst the average general prac titioner consultation cost per patient was lower (pound 30 vs pound 37) com pared with the alternative strategy. The cost per patient with complete sym ptom relief at 16 weeks was 35% higher with the antacid-alginate/ranitidine strategy (pound 308.69) compared with the omeprazole strategy (pound 229.2 9). Sensitivity analyses demonstrated that these results were robust over a wide range of plausible assumptions. Conclusions: These results show that an omeprazole strategy is more cost ef fective than an antacid-alginate/ranitidine strategy for the management of acid-related dyspepsia in general practice.