THE OMEGA-PROJECT - A COMPARISON OF 2 DIAGNOSTIC STRATEGIES FOR RISK-ORIENTED AND COST-ORIENTED MANAGEMENT OF DYSPEPSIA

Objectives: In dyspepsia few data are available from the primary care setting on how selective, risk-factor-oriented endoscopy compares with mandatory endoscopy in the diagnostic outcome and in direct and secon dary costs. We studied this in a two-armed multicentre trial (Omega-pr oject) with primary care physicians. Material and methods: Patients we re enrolled and treated by primary care physicians and referred to a g astroenterologist for upper gastrointestinal endoscopy (UGE). Patients were enrolled in the study if they had had epigastric complaints for more than 1 month and no obvious signs or history of organic disease. In the first arm of the study endoscopy was mandatory, in the second s elective, i.e. according to a predefined risk profile. Patients enroll ed were treated with prokinetic drugs for 2 months. A further indicati on for endoscopy was non-response to treatment (reduction of the initi al symptoms score by less than two-thirds) in the study with selective endoscopy and relapse within the 2-month follow-up period in both stu dies. The direct costs from number of consultations with the primary c are physician, UGEs, number of prescriptions per patient and also abse nteeism in days per week were carefully registered in both groups. Res ults: All 172 patients oi the mandatory endoscopy study and 203/656 pa tients enrolled in the selective endoscopy study had an UGE (125 at ad mission, 78 in the follow-up period). Patients were treated for 4 week s (cisapride or domperidone) and thereafter followed for 8 weeks; at t he end of the observation period the response rates were 80% and 79%, respectively. The prevalence of gastric cancers was similar in both gr oups (> 1%) but extrapolation from the data collected with compulsory endoscopy suggests that two-fifths of the anticipated peptic lesions r emained undetected by following the selective strategy. The cost analy sis revealed a 31% cost reduction with the selective strategy - in the Swiss cost system - through a reduction in the number of endoscopies by 67%.Conclusion: Selective UGE is cheaper and appears not to comprom ise the response to prokinetics, however, its diagnostic power is less than with mandatory UGE.