Background-Dyspepsia drug costs account for nearly 0.5% of the National Hea
lth Service budget. We hypothesised that improved management of dyspepsia w
ould lead to reduced drug costs.
Aim-To determine whether a multifaceted educational strategy for general pr
actitioners aimed at improving quality of dyspepsia management can control
dyspepsia costs without increasing demand for endoscopy.
Methods-A multifaceted educational intervention was delivered to general pr
actitioners in West Gloucestershire but not to those in the east of the cou
nty. Dyspepsia drug costs, the primary outcome measure, were obtained from
the Prescription Pricing Authority and compared between the two sides of th
e county. Referral rates for endoscopy, admission to the gastrointestinal b
leed unit, and delayed diagnosis of gastric cancer were secondary measures
recorded in West Gloucestershire only.
Results-Following the intervention, drug costs declined and then stabilised
in West Gloucestershire. Drug costs peaked in the control group 15 months
after those in the intervention group. Using an autoregressive integrated m
oving average model it was estimated the overall costs in the intervention
group reduced by 57.9 pence per head of population per half year (95% confi
dence interval 45.8-69.9 pence/half year; p <0.0001) in comparison with the
control group. This difference was maintained for three consecutive years
resulting in a cumulative saving of pound1.13 million. Referral rates for u
pper gastrointestinal endoscopy remained stable during the study period.
Conclusion-A multifaceted educational intervention for general practitioner
s designed to improve the quality of care of patients with dyspepsia is an
effective means of controlling dyspepsia drug costs without increasing dema
nd for endoscopy.