PMID- 18057189
OWN - NLM
STAT- MEDLINE
DCOM- 20080331
LR  - 20140730
IS  - 0272-989X (Print)
IS  - 0272-989X (Linking)
VI  - 28
IP  - 1
DP  - 2008 Jan-Feb
TI  - A second-order simulation model of the cost-effectiveness of managing dyspepsia 
      in the United States.
PG  - 44-55
AB  - 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.
FAU - Barton, Pelham M
AU  - Barton PM
AD  - Health Economics Facility, University of Birmingham, UK.
FAU - Moayyedi, Paul
AU  - Moayyedi P
FAU - Talley, Nicholas J
AU  - Talley NJ
FAU - Vakil, Nimish B
AU  - Vakil NB
FAU - Delaney, Brendan C
AU  - Delaney BC
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20071205
PL  - United States
TA  - Med Decis Making
JT  - Medical decision making : an international journal of the Society for Medical 
      Decision Making
JID - 8109073
SB  - IM
MH  - Adult
MH  - Cost-Benefit Analysis
MH  - Dyspepsia/*drug therapy/economics
MH  - Financing, Personal
MH  - Helicobacter pylori/drug effects/isolation & purification
MH  - Humans
MH  - Meta-Analysis as Topic
MH  - Middle Aged
MH  - *Models, Statistical
MH  - Patient Acceptance of Health Care
MH  - Quality-Adjusted Life Years
MH  - Sampling Studies
MH  - United States
EDAT- 2007/12/07 09:00
MHDA- 2008/04/01 09:00
CRDT- 2007/12/07 09:00
PHST- 2007/12/07 09:00 [pubmed]
PHST- 2008/04/01 09:00 [medline]
PHST- 2007/12/07 09:00 [entrez]
AID - 0272989X07309644 [pii]
AID - 10.1177/0272989X07309644 [doi]
PST - ppublish
SO  - Med Decis Making. 2008 Jan-Feb;28(1):44-55. doi: 10.1177/0272989X07309644. Epub 
      2007 Dec 5.