A Second-Order Simulation Model of the Cost-Effectiveness of Managing Dyspepsia in the United States

Medical Decision Making - Tập 28 Số 1 - Trang 44-55 - 2008
Pelham Barton1, Paul Moayyedi2, Nicholas J. Talley3, Nimish Vakil4, Brendan Delaney5
1Health Economics Facility, University of Birmingham, UK
2Department of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
3Center for Enteric Neurosciences and Translational Epidemiological Research (CENTER), Mayo Clinic College of Medicine, Rochester, Minnesota, Department of Medicine, University of Sydney, Sydney, Australia
4University of Wisconsin Medical School, Milwaukee, Wisconsin
5Department of Primary Care and General Practice, University of Birmingham, UK

Tóm tắt

Background. The ``gold-standard'' evidence of effectiveness for a clinical practice guideline is the randomized controlled trial (RCT), although RCTs have a limited ability to explore potential management strategies for a chronic disease where these interact over time. Modeling can be used to fill this gap, and models have become increasingly complex, with both dynamic sampling and representation of second-order uncertainty to provide more precise estimates. However, both simulation modeling and probabilistic sensitivity analysis are rarely used together. The objective of this study was to explore uncertainty in controversial areas of the 2005 American Gastroenterology Association position statement on the management of dyspepsia. Methods. Individual sampling model, incorporating a second-order probabilistic sensitivity analysis. Population. US adult patients presenting in primary care with dyspepsia. Interventions compared: empirical acid suppression, test and treat for Helicobacter pylori, initial endoscopy, acid suppression then endoscopy, test and treat then proton pump inhibitor (PPI) then endoscopy. Outcomes. Cost-effectiveness, quality-adjusted life years, and costs in US dollars from a societal perspective, measured over a 5-year period. Data sources: mainly Cochrane meta-analyses. Results. Endoscopy was dominated at all ages by other strategies. PPI therapy was the most cost-effective strategy in 30-year-olds with a low prevalence of H. pylori. In 60-year-olds, H. pylori test and treat was the most cost-effective option. Conclusions. Acid suppression alone was more cost-effective than either endoscopy or H. pylori test and treat in younger dyspepsia patients with a low prevalence of infection.

Từ khóa


Tài liệu tham khảo

10.1111/j.1524-4733.2005.00045.x

10.1177/0272989X9301300409

10.1258/135581904322987535

10.1053/j.gastro.2005.09.019

10.1053/j.gastro.2005.09.020

10.1053/j.gastro.2005.03.004

10.1053/gast.1996.v110.pm8536890

10.1136/bmj.312.7042.1321

10.1097/00004836-199712000-00002

10.3310/hta4390

Phillips C., 1996, Br J Med Econ., 10, 47

Ebell MH, 1997, J Fam Pract., 44, 545

10.7326/0003-4819-126-4-199702150-00004

Sonnenberg A., 1997, Gastroenterol Int., 10, 1

McIntyre AM, 1997, Int J Clin Pract, 51, 276, 10.1111/j.1742-1241.1997.tb11459.x

10.1053/gast.2002.33019

10.3310/hta8360

Talley NJ, 1991, Gastroenterol Int., 4, 145

10.1111/j.1572-0241.2001.03775.x

Chiba N., 2003, Gastroenterology, 124, A1572

Armstrong D., 1999, Yale J Biol Med., 72, 93

www.drugstore.com. Accessed 1 April 2004.

10.1097/01.MLR.0000044901.57067.19

Dyspepsia, 2004, Managing Adults in Primary Care

10.1093/fampra/17.suppl_2.S12

10.1111/j.1572-0241.2003.08724.x

10.1053/j.gastro.2004.08.026

10.1111/j.1572-0241.2003.08724.x

10.1177/0272989X9701700414

10.1097/00042737-200406000-00007

10.1191/0962280202sm304ra

Delaney BC, 2003, The Cochrane Library

10.1016/S0016-5085(08)80247-8

Ciba N., 2002, BMJ., 324, 1012, 10.1136/bmj.324.7344.1012

Jarbol D., 2004, Dig Dis Wk., A530

Sonnenberg A., 1995, Aliment Pharmacol Ther., 9, 3

Cullen DJE, 1993, Gastroenterology, 104, A60

10.3109/00365529008997621

Kuipers EJ, 1995, Aliment Pharmacol Ther., 9, 59

10.1016/0016-5085(92)90764-P

10.1136/gut.44.2008.S1

10.1136/gut.31.4.401

10.1136/bmj.322.7291.898

Cullen DJE, 1993, Gastroenterology, 104, A60

Agreus L., 2002, Gut, 50, iv2, 10.1136/gut.50.suppl_4.iv2

10.1053/gast.1997.v112.pm9178669

Ford A., 2003, The Cochrane Library

van Pinxteren B., 2003, The Cochrane Library

10.1023/A:1018822532736

10.1111/j.1572-0241.1998.00238.x

10.1016/0016-5085(88)90162-X

10.1016/0016-5085(92)91790-B

10.1016/S0016-5107(96)70319-X

10.1046/j.1365-2036.2001.01128.x

10.1046/j.1365-2036.2001.00904.x

Delaney BC, 2004, BMJ., 328, 1388, 10.1136/bmj.328.7453.1388

10.1046/j.1365-2036.2003.01575.x

Groeneveld PW, 2001, Am J Gastroenterol., 96, 338, 10.1111/j.1572-0241.2001.03516.x

Thông tin
Thông tin xuất bản

Medical Decision Making

Tập 28 Số 1

44-55

Thông tin tác giả