Related Experiment Videos
Evaluation of initial noninvasive therapy in pediatric patients presenting with suspected ulcer disease
A D Olson1, A M Fendrick, D Deutsch
1Department of Pediatrics, School of Public Health, University of Michigan, Ann Arbor, USA.
Insights
Empiric antisecretory therapy is the most cost-effective treatment for pediatric dyspepsia, reducing endoscopies by 40%. This approach targets Helicobacter pylori treatment only when necessary, improving clinical and economic outcomes.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Infectious Disease Management
Background:
- Dyspepsia is a common condition in children, with various diagnostic and treatment strategies available.
- Helicobacter pylori infection is a significant factor in pediatric dyspepsia, necessitating effective management approaches.
Purpose of the Study:
- To compare the clinical and economic impact of five distinct treatment strategies for pediatric dyspepsia.
- To identify the most cost-effective approach for managing dyspepsia in children, considering diagnostic procedures and empiric treatments.
Main Methods:
- A decision analysis model was developed using data from published literature on duodenal ulcer disease and H. pylori infection.
- Cost inputs were based on third-party payer reimbursements, with endoscopy performed upon symptom recurrence for noninvasive strategies.
Main Results:
- Empiric antisecretory therapy was the most cost-effective strategy at $1160 per child.
- This strategy eliminated 40% of diagnostic endoscopies and limited antibiotic use to 4% of patients with H. pylori.
- Cost-effectiveness was sensitive to endoscopy costs and symptom recurrence rates.
Conclusions:
- Empiric antisecretory treatment presents the most cost-effective approach for managing pediatric dyspepsia.
- Further research is needed to ascertain the precise symptom recurrence rates following empiric antisecretory treatment in children.
Objective:
To compare the clinical and economic effects of five likely treatment strategies in children with dyspepsia: initial diagnostic endoscopy (EGD) with biopsy for Helicobacter pylori infection; initial EGD without biopsy; H. pylori serology screening and treatment for H. pylori if positive; empiric treatment with antisecretory therapy; and empiric treatment for H. pylori with antibiotics and antisecretory therapy.
Methods:
Our decision analysis model incorporated data from published literature on the incidence of duodenal ulcer disease and effect of H. pylori infection. Cost inputs were derived from payments made by third-party payers. For the three noninvasive strategies that did not include immediate endoscopy, endoscopy was performed on the first episode of symptom recurrence.
Results:
The estimated costs per child evaluated for each strategy were: EGD with biopsy, $1458; EGD alone, $1248; H. pylori serology, $1224; antisecretory, $1160; and antisecretory-antibiotic, $1164. Results were sensitive to the costs of EGD and the likelihood of recurrent symptoms in children. When the cost of endoscopy fell below $950 or if over 65% of patients without ulcers eventually underwent endoscopy, there was no longer a cost advantage for initial noninvasive treatment when compared with EGD alone strategy.
Conclusion:
In a decision analysis model, empiric antisecretory treatment in children with dyspepsia was most cost-effective, eliminating 40% of endoscopies and leading to antibiotic use in only those patients with H. pylori (4%). Further studies to determine the actual recurrence rate of symptoms after empiric antisecretory treatment of children with dyspepsia are required.