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Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia

Objective: To compare a Helicobacter pylori "test and treat'' strategy with prompt endoscopy in young Asians with dyspepsia. Methods: A randomised, prospective study was carried out on uninvestigated dyspeptics aged <45 years in a single (academic) primary care centre. Patients wer...

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Main Authors: Mahadeva, S., Chia, Y.C., Vinothini, A., Mohazmi, M., Goh, K.L.
Format: Article
Published: BMJ Publishing Group 2008
Subjects:
R Medicine
Online Access:http://eprints.um.edu.my/10466/
http://gut.bmj.com/content/57/9/1214
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spelling my.um.eprints.104662019-09-11T03:00:54Z http://eprints.um.edu.my/10466/ Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia Mahadeva, S. Chia, Y.C. Vinothini, A. Mohazmi, M. Goh, K.L. R Medicine Objective: To compare a Helicobacter pylori "test and treat'' strategy with prompt endoscopy in young Asians with dyspepsia. Methods: A randomised, prospective study was carried out on uninvestigated dyspeptics aged <45 years in a single (academic) primary care centre. Patients were randomised to either a C-13 urea breath test (UBT) or prompt endoscopy (oesophagogastroduodenoscopy (OGD) and followed-up for 12 months. Results: 432 patients (mean (SD) age 30 (8) years, male 46%, ethnicity: Malays 33.3%, Chinese 30.6%, Indians 34.7%) were randomised to UBT (n = 222) or OGD (n = 210). 387 (89.6%) patients completed the study. At 12 months, there was no difference in symptom change (measured by the Leeds Dyspepsia Questionnaire) between the two groups, but more patients were very satisfied (40.0% vs 21.6%, p < 0.0001) in the OGD group. More additional endoscopy was performed in the UBT group (25 vs 10, p = 0.03), but medication consumption was higher in the OGD group (proton pump inhibitor 3.6 (8.8) vs 2.0 (7.5) weeks, p < 0.001; H2 receptor antagonist 5.3 (9.7) vs 3.9 (9.2) weeks, p = 0.017; prokinetics 1.4 (4.7) vs 0.4 (2.5) weeks, p < 0.001) and no differences in medical consultation were noted. The median cost of the initial prompt endoscopy approach at 12 months was significantly higher than a "test and treat'' strategy (US$179.05 vs US$87.10, p < 0.0001). Conclusion: A H pylori "test and treat'' strategy is more cost-effective but less satisfying than prompt endoscopy in the management of young Asian patients with uncomplicated dyspepsia. BMJ Publishing Group 2008 Article PeerReviewed Mahadeva, S. and Chia, Y.C. and Vinothini, A. and Mohazmi, M. and Goh, K.L. (2008) Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia. Gut, 57 (9). pp. 1214-1220. ISSN 0017-5749 http://gut.bmj.com/content/57/9/1214
institution Universiti Malaya
building UM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaya
content_source UM Research Repository
url_provider http://eprints.um.edu.my/
topic R Medicine
spellingShingle R Medicine
Mahadeva, S.
Chia, Y.C.
Vinothini, A.
Mohazmi, M.
Goh, K.L.
Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
description Objective: To compare a Helicobacter pylori "test and treat'' strategy with prompt endoscopy in young Asians with dyspepsia. Methods: A randomised, prospective study was carried out on uninvestigated dyspeptics aged <45 years in a single (academic) primary care centre. Patients were randomised to either a C-13 urea breath test (UBT) or prompt endoscopy (oesophagogastroduodenoscopy (OGD) and followed-up for 12 months. Results: 432 patients (mean (SD) age 30 (8) years, male 46%, ethnicity: Malays 33.3%, Chinese 30.6%, Indians 34.7%) were randomised to UBT (n = 222) or OGD (n = 210). 387 (89.6%) patients completed the study. At 12 months, there was no difference in symptom change (measured by the Leeds Dyspepsia Questionnaire) between the two groups, but more patients were very satisfied (40.0% vs 21.6%, p < 0.0001) in the OGD group. More additional endoscopy was performed in the UBT group (25 vs 10, p = 0.03), but medication consumption was higher in the OGD group (proton pump inhibitor 3.6 (8.8) vs 2.0 (7.5) weeks, p < 0.001; H2 receptor antagonist 5.3 (9.7) vs 3.9 (9.2) weeks, p = 0.017; prokinetics 1.4 (4.7) vs 0.4 (2.5) weeks, p < 0.001) and no differences in medical consultation were noted. The median cost of the initial prompt endoscopy approach at 12 months was significantly higher than a "test and treat'' strategy (US$179.05 vs US$87.10, p < 0.0001). Conclusion: A H pylori "test and treat'' strategy is more cost-effective but less satisfying than prompt endoscopy in the management of young Asian patients with uncomplicated dyspepsia.
format Article
author Mahadeva, S.
Chia, Y.C.
Vinothini, A.
Mohazmi, M.
Goh, K.L.
author_facet Mahadeva, S.
Chia, Y.C.
Vinothini, A.
Mohazmi, M.
Goh, K.L.
author_sort Mahadeva, S.
title Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
title_short Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
title_full Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
title_fullStr Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
title_full_unstemmed Cost-effectiveness of and satisfaction with a Helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young Asians with dyspepsia
title_sort cost-effectiveness of and satisfaction with a helicobacter pylori "test and treat'' strategy compared with prompt endoscopy in young asians with dyspepsia
publisher BMJ Publishing Group
publishDate 2008
url http://eprints.um.edu.my/10466/
http://gut.bmj.com/content/57/9/1214
_version_ 1646210124850659328
score 13.211869

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