TITLE

COST EFFECTIVENESS OF H PYLORI 'TEST AND TREAT' VERSUS PPI FOR UNINVESTIGATED DYSPEPSIA: MODELLING AND META-ANALYSIS IN THE DESIGN OF THE MRC-CUBE TRIAL

AUTHOR(S)
Delaney, B.C.; Moayyedi, P.; Logan, R.F.A.; Qume, M.; Roalfe, A.; Wilson, S.; Barton, P.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA80
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Only a small number of trials have directly addressed the management of patients with "uninvestigated" dyspepsia. The design of trials to determine cost effectiveness is more complex than efficacy trials, and can be enhanced by pre-trial modelling. Methods: A simulation model of 72 alternative management strategies for a dyspeptic patient was constructed. The model simulated the flow of individual patients with potential upper Gl disorders through potential investigations and therapies, including endoscopy, non-invasive testing for H pylori, acid suppression therapy, and H pylori eradication. Epidemiological data and meta-analyses were used to specify parameters within the model. The model was used to establish the important comparisons for future research and to establish likely effect sizes in terms of cost and efficacy. Sensitivity analysis explored potential effect modifiers and the MRC-CUBE study was designed and powered on the basis of the model. Results: Recent trials have supported some of the model's findings, in that only empiric acid suppression with either an antacid or a PPI, or H pylori "test and treat", followed by acid suppression were cost effective. Test and treat was more effective, but more costly than empiric acid suppression alone. Based on the model, the minimum effect size would be 7%, assuming a maximum willingness to pay For a patient free of dyspepsia for a year of 100, and a control event rate of 70%. 1940 patients would be required for an α of 0.05 and β 0.1. Conclusions: The MRC-CUBE trial is about to start recruitment in 60 practices, a large, multi-centre trial being justified on the basis of the model. As well as informing the selection of appropriate comparisons, pre-trial modelling enables cost effectiveness trials to be powered for cost as well as effectiveness outcomes.
ACCESSION #
9747821

 

Related Articles

  • Economic consequences of near-patient test results: the case of tests for the Helicobacter Pylori bacterium in dyspepsia. Fauli, Siri; Thue, Geir // European Journal of Health Economics;Sep2008, Vol. 9 Issue 3, p221 

    We have developed a model for economic evaluation related to the diagnostic accuracy (sensitivity and specificity) of near patient tests used in office laboratories, as opposed to using hospital-based tests. Blood-sample based tests to detect the bacterium Helicobacter Pylori (HP) are useful in...

  • Test-and-Treat Strategy for Dyspepsia Is Supported. Walling, Anne D. // American Family Physician;8/15/2002, Vol. 66 Issue 4, p660 

    Presents an abstracts of studies on dyspepsia. 'Treating Helicobacter pylori in Primary Care Patients With Uninvestigated Dyspepsia: The Canadian Adult Dyspepsia Empiric Treatment--Helicobacter pylori Positive (CADET-Hp) Randomised Controlled Trial,' by N. Chiba et al., from the April 27, 2002...

  • Chronic Gastritis in Dermatitis Herpetiformis: A Controlled Study. Alakoski, Anna; Salmi, Teea T.; Hervonen, Kaisa; Kautiainen, Hannu; Salo, Maarit; Kaukinen, Katri; Reunala, Timo; Collin, Pekka // Clinical & Developmental Immunology;2012, p1 

    Background and Objective. Previous small studies suggest that chronic atrophic gastritis is common in dermatitis herpetiformis (DH). We here examined the frequency and topography of chronic gastritis in 93 untreated DH subjects and in 186 controls with dyspepsia. Methods. Specimens were drawn...

  • NONULCER DYSPEPSIA: HELICOBACTOR PYLORI OR IDIOPATHY? Kozol, Robert A. // American Journal of Gastroenterology;Mar1996, Vol. 91 Issue 3, p419 

    Discusses an overview of studies on anti-Helicobacter pylori therapy in patients with functional or non ulcer dyspepsia. Advantage of the eradication of Helicobacter pylori in patients with peptic ulcer; Result of clinical trials of anti-Helicobacter pylori therapy; Strengths of the study...

  • HELICOBACTER PYLORI IN PEDIATRIC NONULCER DYSPEPSIA: PATHOGEN OR COMMENSAL? Tolia, Vasundhara // American Journal of Gastroenterology;Jun1995, Vol. 90 Issue 6, p865 

    Discusses the role of Helicobacter pylori in pediatric non-ulcer dyspepsia. Mucosal abnormalities in the gastrointestinal tract; Details of studies that demonstrated significant and sustained symptomatic improvement in children with H. pylori gastritis after treatment; Evaluation of results of...

  • Pooling data on different probiotics is not appropriate to assess the efficacy of probiotics. Szajewska, Hania // European Journal of Pediatrics;Jul2014, Vol. 173 Issue 7, p975 

    A letter to the editor is presented in response to the article "Meta-analysis of randomized controlled trials on the efficacy of probiotics in Helicobacter pylori eradication therapy in children" by S. Li and colleagues.

  • One day treatment is as effective as seven to eradicate H pylori.  // BMJ: British Medical Journal (International Edition);3/13/2004, Vol. 328 Issue 7440, p592 

    Discusses whether a one day treatment of Helicobacter pylori is as effective as a seven day regimen in patients with dyspepsia. Rates of treatment success; Treatment side effects.

  • Influence of Helicobacter pylori infection on in vitro responsiveness of gastric fundus to agonists and to stimulation of enteric nerves in Mongolian gerbils. Takehara, Yusuke; Mizuta, Yohei; Isomoto, Hajime; Ohnita, Ken; Yoshimura, Masaya; Nakamura, Takashi; Takeshima, Fuminao; Omagari, Katsuhisa; Murase, Kunihiko; Murata, Ikuo; Taniyama, Kohtaro; Kohno, Shigeru // Journal of Gastroenterology;2002, Vol. 37 Issue 8, p589 

    Background. It has recently been proposed that disturbed gastric adaptive relaxation may play a role in functional dyspepsia (FD). However, the effect of Helicobacter pylori infection, which may be one of multiple factors associated with FD, on gastric relaxation is not clear. The aim of this...

  • AKT answer relating to management of dyspepsia.  // InnovAiT;Apr2011, Vol. 4 Issue 4, p244 

    The article offers information on how to manage dyspepsia which involves the use of a proton pump inhibitor (PPI) or test and treat for helicobacter pylori (H. pylori) and the prescription of a prokinetic or an H2-receptor antagonist for one month.

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics