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Tuesday, 17 October 2006
38

TEST AND TREAT FOR HELICOBACTER PYLORI V ACID SUPPRESSION ALONE FOR DYSPEPSIA, STOCHASTIC COST-EFFECTIVENESS ANALYSIS OF THE MRC-CUBE RANDOMISED CONTROLLED TRIAL

Brendan C. Delaney, MD1, Michelle Qume, PhD2, Paul Moayyedi, PhD3, Richard FA Logan, MD4, Cliodna McNulty, PhD5, Richard Hobbs2, Sue Wilson, PhD2, Alex Ford6, and Cathy Elliott4. (1) University of Birmingham, Birmingham, United Kingdom, (2) The University of Birmingham, Birmingham, United Kingdom, (3) McMaster University, Hamilton, ON, Canada, (4) The University of Nottingham, Nottingham, United Kingdom, (5) Gloucester Royal Hospital, Gloucester, United Kingdom, (6) Leeds Royal Infirmary, Leeds, United Kingdom

Purpose: Recent guidelines from NICE and the AGA have recommended either testing and treating for H.pylori or acid suppression as first line treatment for dyspepsia . A Cochrane review of RCTs has shown that test and treat is more cost-effective than endoscopy-based management, the MRC CUBE study aimed to determine whether test and treat is also cost-effective as first line management.

Methods: Individual patient RCT, managed using the MidReC-en e-Trials portal. Patients aged 18 and over with epigastric pain or heartburn were randomised to either receive a C13 Urea breath test for H.pylori, followed by eradication therapy if positive or no testing. All patients received omeprazole 20mg od for 4 weeks. Dyspepsia symptoms (Short Form Leeds Dyspepsia Questionnaire), Quality of Life (EQ-5D) and health resource utilisation (costs were measured at baseline, 12 weeks and 52 weeks. Stochastic economic analysis using incremental net benefit.

Results: 699 subjects were recruited from 80 practices across England. 342 were male and the ages ranged from 18 to 65 with mean 41. Data were returned for 556 (80%), 558 (81%) and 666 (95%) for SF LDQ, EQ-5D and resource utilisation respectively at 12 months. 331 subjects had predominant epigastric pain and 277 heartburn. The mean SF-LDQ scores changed from 15.5 and 17.0 to 6.8 and 8.6 (p<0.003) for test and treat and acid suppression respectively at 12 months. In terms of cost-effectiveness, test and treat generated an additional 0.04 QALYs at an additional cost of $7 ($237 v. £230). A plot of Incremental Net Monetary Benefit v the ceiling ratio shows that the two strategies were equivalent in cost-effectiveness, but with a wide uncertainty as the ceiling ratio increases.

Conclusions: H.pylori test and treat is similarly cost-effective to PPI in the initial management of dyspepsia, having equal QALYs and costs, but results in a small, but significant improvement in dyspepsia symptoms at one year.


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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)