Use of H2-receptor antagonists in patients with dyspepsia and heartburn: a cost comparison

Med J Aust. 1991 Jul 1;155(1):20-6.

Abstract

Objective: Under the Pharmaceutical Benefits Scheme, the use of H2-receptor antagonists (H2A) in the treatment of dyspepsia and heartburn is only subsidised when there is a proven diagnosis of ulcer. This study compared the costs of this Australian practice with a simulation of British practice, which allows unrestricted prescribing of subsidised H2A.

Design: Patients with heartburn and/or dyspepsia were prospectively randomised to either a "British" group treated freely at the discretion of their general practitioner without necessarily being investigated or an "Australian" group where use of H2A was allowed only after gastroscopy or a barium meal had demonstrated a peptic ulcer or ulcerative oesophagitis. The patients were followed up for six months and all direct and indirect costs were recorded.

Setting: Forty-nine Sydney general practitioners recruited primary care patients for the study.

Patients: Any patient with heartburn or dyspepsia was considered for recruitment; 139 patients entered the study and 137 completed it.

Main outcome measures: The outcome measures were the costs of general practitioner consultations, specialist consultations, radiology and gastroscopy, other tests, H2A, other medications, personal costs, and total cost per patient.

Results: The cumulative total cost per patient at the end of the study was equivalent in the "Australian" ($392) and "British" ($406) groups. A higher initial cost per patient of H2A in the "British" group was offset by a rapid decrease in the proportion that continued to use H2A and by the cost of specialist consultations and investigations in the "Australian" group.

Conclusion: Over a six-month period the cost of early investigation of heartburn and dyspepsia was equivalent to the cost of a therapeutic trial of H2A.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Costs and Cost Analysis
  • Direct Service Costs
  • Dyspepsia / drug therapy*
  • Dyspepsia / economics
  • Dyspepsia / etiology
  • Esophagitis, Peptic / complications
  • Esophagitis, Peptic / diagnosis
  • Esophagitis, Peptic / economics
  • Female
  • Follow-Up Studies
  • Heartburn / drug therapy*
  • Heartburn / economics
  • Heartburn / etiology
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / complications
  • Peptic Ulcer / diagnosis
  • Peptic Ulcer / economics
  • Prospective Studies
  • United Kingdom

Substances

  • Histamine H2 Antagonists