Economic Analyses of Present Management Strategies and Nonprescription Therapy in Treatment of Dyspepsia

Abstract

Although pharmaceutical as well as healthcare developments move forward, the initial management of dyspepsia, which usually starts off in primary care, still remains difficult to decide on. An average primary care physician deals with dyspepsia almost daily, and it accounts for major healthcare budgets in most countries. Unfortunately, evidence on which to base the best initial management strategy is still inconclusive. Most studies to date have reported on single drug comparisons or on comparison with prompt endoscopy and mainly involved patients either with persisting dyspeptic symptoms or with predominantly reflux-like symptoms, referred to secondary care. Several meta-analyses and reviews have been done to address important questions concerning treatment strategies for patients with dyspeptic symptoms. The Cochrane review on initial management of dyspepsia showed that only a few studies, mostly of inadequate methodology, dealt with this subject, and this Cochrane review was recently withdrawn [1]. Investigators concluded that large gaps in knowledge on the most cost-effective management strategy for uninvestigated dyspepsia still exist. Although new research was published, the final verdict on factors to be involved in the initial decision has still not been reached. Consequently, current guidelines for management of dyspepsia are inconsistent, and the cost-effectiveness of chosen strategies has substantial unknown variance depending on cultural and economical context.