Economic evaluation of a randomized trial comparinghelicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting

Klok, Rogier M.; Arents, N. L. A.; Vries, Robin de; Thijs, J. C.; Brouwers, Jacobus; Kleibeuker, Jan H.; Postma, Maarten J.

doi:10.1016/j.clinthera.2005.10.011

Cited by 12 publications

(8 citation statements)

References 33 publications

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“…32, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 In summary, most of the decision analysis and economic models confirm test-and-treat to be better than prompt endoscopy. 32, 43, 46, 47, 49, 50, 52, 57, 60 The preference for the test-and-treat strategy over empirical antisecretory therapy is also suggested by most of the economic models (Table 3). 43, 45, 47, 51, 52, 53, 55 …”

Section: Decision Analysis and Economic Modelsmentioning

confidence: 91%

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Gisbert

Calvet

2013

Clinical and Translational Gastroenterology

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OBJECTIVES:Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic–therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia.METHODS:Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses.RESULTS:Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori.CONCLUSIONS:The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that “the only good H. pylori is a dead H. pylori”.

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Section: Decision Analysis and Economic Modelsmentioning

confidence: 91%

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Gisbert

Calvet

2013

Clinical and Translational Gastroenterology

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“…In primary care, empirical prescription of antisecretory drugs is often the first approach of treatment, but test and treat H. pylori leads to reduced endoscopic workload and was demonstrated to be more cost-effective compared to the use of empiric antisecretory therapy [35,39] .…”

Section: Resultsmentioning

confidence: 99%

“…Further studies also evaluated symptom reduction or similar clinical outcome in patients treated with H. pylori eradication compared to endoscopy [32][33][34] . From the economic point of view, test and treat H. pylori is more cost-effective than prompt endoscopy and therefore should be considered to be the first diagnostic approach in the initial management of dyspepsia [35] .…”

Section: H Pylori Test and Treat/eradication Versus Prompt Endoscopymentioning

confidence: 99%

Dyspepsia and <i>Helicobacter pylori</i>

Selgrad

Kandulski

Malfertheiner³

2008

Dig Dis

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Dyspepsia is defined as a chronic or recurrent pain centered in the upper abdomen. Dyspeptic symptoms have a high prevalence in the population and represent a common reason for patients to see a primary care physician. Therefore, dyspepsia displays a major health care burden and produces high socioeconomic costs. The etiology of dyspeptic symptoms is various and complex and has opened a wide spectrum of putative mechanisms. In a subset of patients dyspeptic symptoms are likely to originate from Helicobacter pylori infection. Population-based studies have demonstrated that H. pylori is detected more frequently in dyspeptic patients compared to controls. H. pylori eradication therapy gives modest but significant benefit in non-ulcer dyspepsia and leads to long-term symptom improvement. It also reduces the risk of developing peptic ulcer disease and other H. pylori-related gastric pathologies (i.e. atrophic gastritis, gastric cancer). The main therapeutic strategy for managing dyspepsia in patients under the age of 45 years is ‘test and treat’. H. pylori eradication is recommended in patients with dyspepsia and no other gastroduodenal abnormalities than H. pylori induced gastritis. In patients presenting with alarm features a prompt upper endoscopy should be performed to exclude peptic ulcer disease, esophageal and gastric malignancies or other more rare upper gastrointestinal diseases.

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“…There was a 10% relative risk reduction in the H. pylori eradication group (95% CI 6 to 14%) compared to placebo, leading to the conclusion that eradication therapy has a small but statistically significant beneficial effect in H. pylori-positive functional dyspepsia [32]. Similarly, an economic analysis of a H. pylori test-and-treat strategy versus a prompt endoscopy approach in primary care setting performed in the Netherlands, suggested that the former was more costeffective than the latter in the initial management of dyspepsia in general practice [36]. Mazzoleni et al demonstrated, in a population with a high prevalence of H. pylori infection, the benefit of eradication in patients with normal endoscopy but not in those with erosive gastritis [34].…”

Section: Non-ulcer Dyspepsiamentioning

confidence: 99%

Helicobacter pylori and Non‐Malignant Diseases

et al. 2006

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The prevalence of Helicobacter pylori-associated peptic ulcers, in particular duodenal ulcers, is decreasing following decreasing prevalence of H. pylori infection, while the frequency of non-steroidal anti-inflammatory drugs (NSAIDs)-induced and H. pylori-negative idiopathic ulcers is increasing. The incidence of bleeding ulcers has been stable during the last decades. Several putative H. pylori virulence genes, i.e., cag, vacA, babA, or dupA, as well as host-related genetic factors like IL-1beta and TNFalpha-gene polymorphism, have been proposed as risk factors for duodenal ulcer. H. pylori eradication may prevent NSAID complications, in particular, when it is performed before introduction of NSAIDs. There is a complex association between H. pylori and gastroesophageal reflux disease (GERD), and the impact of H. pylori eradication on the appearance of GERD symptoms depends on various host- and bacteria-related factors. Eradication of H. pylori in GERD is recommended in patients before instauration of a long-term PPI treatment to prevent the development of gastric atrophy. A small proportion (10%) of non-ulcer dyspepsia cases may be attributed to H. pylori and may benefit from eradication treatment. A test-and-treat strategy is more cost-effective than prompt endoscopy in the initial management of dyspepsia.

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Economic evaluation of a randomized trial comparinghelicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting

Cited by 12 publications

References 33 publications

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

Dyspepsia and <i>Helicobacter pylori</i>

Helicobacter pylori and Non‐Malignant Diseases

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