Moayyedi, P.; Delaney, B.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA16
Academic Journal
Introduction: Proton pump inhibitor (PPI) therapy is an established treatment for gastro-oesophageal reflux disease, but their efficacy in non-ulcer dyspepsia (NUD) is controversial. Randomised controlled trials (RCTs) have given conflicting results so we have conducted a rigorous Cochrane systematic review of the literature and evaluated the cost effectiveness of this strategy. Methods: The Cochrane Controlled Trials Register, Medline, EMBASE, and CINAHL electronic databases were searched for RCTs evaluating PPIs in NUD. Experts in the field and pharmaceutical companies were contacted for information on any unpublished RCTs. A single investigator reviewed papers generated from this search according to predefined eligibility and validity criteria. Outcomes were dichotomised into dyspepsia minimal/resolved versus same/ worse. The results were entered into a Markov model (Tree Age version 4.0) that compared costs and effects of PPI with antacid therapy over a 12 month period from a health service perspective. Full dose PPI was assumed to cost 22.75, Iow dose PPI 12.43, antacid 2.48/month, and a GP visit 18. Monte Carlo simulations of 5000 patients were performed using the 95% CI of the meta-analysis data to give stochastic estimates of cost effectiveness. Results: Seven RCTs evaluating 3031 patients for 2-8 weeks were eligible for the review. PPI therapy was significantly superior to placebo in treating NUD (relative risk (RR) of remaining dyspeptic = 0.86; 95% CI = 0.80-0.93, p < 0.0001; random effects model). There was significant heterogeneity between the studies. The number needed to treat to cure one case of dyspepsia = 9 (95% CI = 6 to 26). Six RCTs evaluating 2032 patients compared high versus Iow dose PPI with no statistical difference in curing NUD symptoms (RR = 0.98; 95% CI = 0.92 to 1.05). The Markov model suggested full dose PPI cost 60/month free from dyspepsia (95% CI = 42-112) while half: dose PPI cost 29/month free of dyspepsia (95% CI = 19-55)....


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