Economic constraints in the diagnosis of peptic ulcer disease.
Background The discovery of Helicobacter pylori and its role in upper gastrointestinal disease has changed the outlook on diagnosis of peptic ulcer disease.
Objectives To address the questions of what types of diagnostic tests and how many of each type are needed to diagnose among patients with dyspepsia as many ulcers as possible at least cost Methods Bayes'formula and a decision tree were used to follow the outcomes of alternative test combinations for ulcer diagnosis.
Results Assuming unlimited resources, only endoscopy of all subjects results in the correct diagnoses of all ulcers, but costs $5600 per diagnosis.
Barium swallow followed by endoscopy is less expensive ($2980), but misses 5% of all ulcers.
Serology for H. pylori followed by endoscopy or barium meal provides relatively high diagnostic yields (85 or 81% of all ulcers detected) at lower costs ($2900 or $1050 per ulcer diagnosis, respectively).
In general, a higher number of ulcers is found at a lower cost if the cheap tests are used to screen patients before subjecting them to the more expensive tests.
Conclusions The ideal work-up depends on the urgency of a correct diagnosis, the willingness to miss some ulcer diagnoses and the availability of resources.
H. pylori serology followed by endoscopy or barium meal represents two cost-effective strategies.
Mots-clés Pascal : Ulcère, Gastroduodénal, Dyspepsie, Helicobacter pylori, Spirillaceae, Spirillales, Bactérie, Questionnaire, Diagnostic, Arbre décision, Analyse coût efficacité, Etude cohorte, Homme, Appareil digestif pathologie, Estomac pathologie, Intestin pathologie, Bactériose, Infection, Economie santé
Mots-clés Pascal anglais : Ulcer, Gastroduodenal, Dyspepsia, Helicobacter pylori, Spirillaceae, Spirillales, Bacteria, Questionnaire, Diagnosis, Decision tree, Cost efficiency analysis, Cohort study, Human, Digestive diseases, Gastric disease, Intestinal disease, Bacteriosis, Infection, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0002064
Code Inist : 002B13B03. Création : 31/05/1999.