The Role of Economic Evaluation in the Diagnosis and Treatment of Helicobacter PyloriInfection

Abstract

The unfolding of the H. pylori story coupled with the high prevalence and economic burden associated with upper gastrointestinal symptoms makes H. pylori-associated disorders an ideal candidate for economic evaluation. As a result of the high quality and quantity of data emerging, H. pylori eradication is cost-effective in individuals with either newly diagnosed or past PUD. The role of eradication in other areas, for example, patients with nonulcer dyspepsia and screening to prevent gastric cancer, may never be worked out to some clinicians' satisfaction. Conflicting reports and the lack of definitive clinical trials have frustrated clinicians. H. pylori diagnosis and treatment have not been integrated into everyday clinical practice. As a result, the enormous potential benefits associated with H. pylori eradication have not been achieved. Economic evaluation is not a panacea to the problems confronting medical services delivery. Assessments of medical practice are methodologically challenging, time-consuming, and expensive. Once the answers are in, it remains difficult to alter an individual provider's patterns of care and integrate the research findings into everyday practice. Further research into physician decision making is necessary to complement the advances being made in determining the value of medical interventions. The fruits of these efforts will be the more efficient delivery of health care services, which, it is hoped, ultimately will improve the health of patients. There is no reason to believe, however, that more attention to effectiveness research would lead to a reduction in health care expenditures. Increasing demands for accountability of medical interventions will propel effectiveness movements. Economic analyses, performed in concert with carefully designed clinical studies, will spur more critical review of health care resource allocation decisions. Despite the limitations, the findings generated from effectiveness research will have a major impact on physician practices, guideline development, and reimbursement decisions. The tendency of clinicians not to pay attention to economic evaluations may lead to missed clinical benefits and unnecessary expenditures. Physicians who have been reluctant to appreciate the information provided by economic evaluation must understand what other stakeholders in health care delivery already have accepted: that the rational basis for cost-effectiveness analysis is the overall improvement in the quality of health care services--not simply a tool to reduce health care costs.