endoscopy with biopsy worth it in nonulcer dyspepsia?

PharmacoEconomics & Outcomes News 424 - 9 Aug 2003 Endoscopy with biopsy worth it in nonulcer dyspepsia? Routine procurement of a biopsy specimen for detection of Helicobacter pylori among patients with nonulcer dyspepsia is more effective than no biopsy, but comes at a greater cost, the "magnitude of which is dependent on the attributable benefit of H pylori eradication" among such patients, says a multinational group of researchers. They constructed a decision-analysis model, using outcomes data obtained from expert opinion and published literature, to assess the cost effectiveness of endoscopy, with or without biopsy, among adult patients (aged < 45 years) with nonulcer dyspepsia. * A 12-month time horizon was considered, and the difference in symptomatic recurrence rate at 1 year between patients in whom H. pylori was successfully or unsuccessfully eradicated was assumed to be 9.9%. The model showed that endoscopy with biopsy would result in 2.72 additional patients asymptomatic at 1 year (cured), for an incremental cost of $Can10 716 per 100 patients treated, ** compared with endoscopy without biopsy. Therefore, endoscopy plus biopsy would enable one additional patient to be cured, but at a "relatively large" additional cost of $Can3940, compared with endoscopy with no biopsy, note the researchers. In sensitivity analysis, only when the difference in symptomatic cure rates dropped to 4%, did endoscopy with biopsy reach a threshold incremental cost of > $Can10 000 per patient cured, compared with endoscopy and no biopsy. However, the researchers acknowledge that this incremental cost-effectiveness threshold is "an empirical one, chosen in the context of the near absence of relevant published data". * The study was supported in part by a grant from AstraZeneca Canada. One of the researchers was affiliated with Abbott Laboratories, Ltd. ** Costs (1999 Canadian dollars) were those associated with pharmacological treatment, physician visits and diagnostic tests, and were calculated from the perspective of a public healthcare payer. Makris N, et al. Cost-effectiveness of routine endoscopic biopsies for Helicobacter pylori detection in patients with non-ulcer dyspepsia. Gastrointestinal Endoscopy 58: 14-22, No. 1, Jul 2003 800943142 1 PharmacoEconomics & Outcomes News 9 Aug 2003 No. 424 1173-5503/10/0424-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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PharmacoEconomics & Outcomes News 424 - 9 Aug 2003

Endoscopy with biopsy worth it innonulcer dyspepsia?

Routine procurement of a biopsy specimen fordetection of Helicobacter pylori among patients withnonulcer dyspepsia is more effective than no biopsy, butcomes at a greater cost, the "magnitude of which isdependent on the attributable benefit of H pylorieradication" among such patients, says a multinationalgroup of researchers.

They constructed a decision-analysis model, usingoutcomes data obtained from expert opinion andpublished literature, to assess the cost effectiveness ofendoscopy, with or without biopsy, among adultpatients (aged < 45 years) with nonulcer dyspepsia.* A12-month time horizon was considered, and thedifference in symptomatic recurrence rate at 1 yearbetween patients in whom H. pylori was successfully orunsuccessfully eradicated was assumed to be 9.9%.

The model showed that endoscopy with biopsy wouldresult in 2.72 additional patients asymptomatic at 1 year(cured), for an incremental cost of $Can10 716 per 100patients treated,** compared with endoscopy withoutbiopsy. Therefore, endoscopy plus biopsy would enableone additional patient to be cured, but at a "relativelylarge" additional cost of $Can3940, compared withendoscopy with no biopsy, note the researchers.

In sensitivity analysis, only when the difference insymptomatic cure rates dropped to 4%, did endoscopywith biopsy reach a threshold incremental cost of >$Can10 000 per patient cured, compared withendoscopy and no biopsy. However, the researchersacknowledge that this incremental cost-effectivenessthreshold is "an empirical one, chosen in the context ofthe near absence of relevant published data".* The study was supported in part by a grant from AstraZenecaCanada. One of the researchers was affiliated with AbbottLaboratories, Ltd.** Costs (1999 Canadian dollars) were those associated withpharmacological treatment, physician visits and diagnostic tests, andwere calculated from the perspective of a public healthcare payer.

Makris N, et al. Cost-effectiveness of routine endoscopic biopsies for Helicobacterpylori detection in patients with non-ulcer dyspepsia. Gastrointestinal Endoscopy58: 14-22, No. 1, Jul 2003 800943142

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