Silverstein M D, Petterson T, Talley N J
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Gastroenterology. 1996 Jan;110(1):72-83. doi: 10.1053/gast.1996.v110.pm8536890.
BACKGROUND & AIMS: Empirical therapy has been proposed for initial management of dyspepsia. The aim of this study was to evaluate initial endoscopy, empirical therapy, and testing for Helicobacter pylori in the management of patients with a new onset of dyspepsia.
Decision analysis was used to compare the direct medical charges in the first year after the onset of dyspepsia for patients managed by initial endoscopy or empirical therapy, with or without initial testing for H. pylori.
Medical care charges were $2162.50 for initial endoscopy and $2122.60 for empirical therapy, a difference of 1.8%. For a 55-year-old adult, life expectancy was 23.49 years for initial endoscopy compared with 23.48 years for empirical therapy. Empirical therapy has lower charges than initial endoscopy when H2-receptor antagonists are used to prevent recurrence of dyspepsia. Initial noninvasive testing for H. pylori has lower charges than initial endoscopy if patients with dyspepsia with H. pylori receive antimicrobial therapy without endoscopy but would have higher charges if patients with H. pylori routinely have endoscopy.
Surprisingly, the choice of optimal management strategy was a "toss-up." Only modest savings may result from practice guidelines that recommend empirical therapy in the management of patients with dyspepsia.
已提出对消化不良进行经验性治疗作为初始管理方法。本研究的目的是评估初始内镜检查、经验性治疗以及幽门螺杆菌检测在新发消化不良患者管理中的作用。
采用决策分析比较消化不良发作后第一年，接受初始内镜检查或经验性治疗的患者（无论是否进行初始幽门螺杆菌检测）的直接医疗费用。
初始内镜检查的医疗费用为2162.50美元，经验性治疗为2122.60美元，相差1.8%。对于一名55岁的成年人，初始内镜检查后的预期寿命为23.49年，经验性治疗为23.48年。当使用H2受体拮抗剂预防消化不良复发时，经验性治疗的费用低于初始内镜检查。如果幽门螺杆菌阳性的消化不良患者不进行内镜检查而接受抗菌治疗，初始幽门螺杆菌非侵入性检测的费用低于初始内镜检查，但如果幽门螺杆菌阳性患者常规进行内镜检查，则费用会更高。
令人惊讶的是，最佳管理策略的选择是“难分高下”。推荐经验性治疗消化不良患者的实践指南可能只会带来适度的费用节省。
