THE COST-EFFECTIVENESS OF TREATING HELICOBACTER PYLORI (HP) NEGATIVE PRIMARY CARE PATIENTS WITH UNINVESTIGATED DYSPEPSIA (UD) USING OMEPRAZOLE, RANITIDINE, CISAPRIDE OR PLACEBO

SJO Veldhuyzen van Zanten¹, N Chiba², D Armstrong³, AN Barkun⁴, ABR Thomson⁵, E Grace⁶, F Ahmad⁶, S Smyth⁶, P Sinclair², L Tanser⁶

¹Halifax, Nova Scotia; ²Guelph, Ontario; ³Hamilton, Ontario; ⁴Montreal, Quebec; ⁵Edmonton, Alberta; ⁶Mississauga, Ontario

PURPOSE: To measure the cost-effectiveness of omeprazole (OME) 20 mg od, ranitidine (RAN) 150 mg bid, cisapride (CIS) 20 mg bid and placebo (PLA) in the management of Hp-negative UD patients.
METHOD: Hp-negative patients by ¹³C-UBT, (n=512) with moderate to severe dyspepsia (score ³4 on a 7-point Likert) were recruited from 35 Canadian family practices. Patients were randomized to OME, RAN, CIS or PLA, for 4 weeks then treated on-demand with the same medication for 5 months. Effectiveness measured by treatment success (score £2) for all patients at 4 weeks and for 4-week responders (score £2) at 6 months. Health care costs were captured using the health care utilization questionnaire. The incremental cost-effectiveness ratio (ICER) is defined as the ratio of the difference in total cost divided by the difference in effectiveness for each management strategy relative to placebo (Dc/De).
RESULTS: At 4 weeks, proportion of patients with treatment success was greater for OME (51%) compared to RAN (36%), CIS (31%) and PLA (23%) (all p<0.01). For 4-week responders, success at 6 months was greater for OME (31%) vs. CIS (13%) and PLA (14%) (p=0.001), not RAN (21%) (p=0.053).
CONCLUSION: In Hp-negative UD patients, OME is more cost effective than CIS. OME offers better results at a slightly higher cost than generic RAN.

Sponsored by AstraZeneca Canada Inc, Mississauga, ON