The order in which drugs are administered for indigestion (dyspepsia) has implications for cost-effectiveness. These are the conclusions of the DIAMOND study, published in an Article in this week's edition of The Lancet, written by Dr Robert Laheij and Corine van Marrewijk, Radbound University Nijmegen Medical Centre, Netherlands, and colleagues.
In this primary-care-based, randomised controlled trial, 664 patients aged 18 years and older who consulted with their family doctor for new onset indigestion were assigned to two different treatment groups. One group (341 patients) received the 'step-up' strategy, receiving stepwise treatment with antacid, H2-receptor antagonists, and proton-pump inhibitors. The other group (323 patients) received the 'step-down' treatment, namely the same drugs above but in reverse order. Each step lasted four weeks and treatment only continued with the next step if symptoms persisted or relapsed within four weeks. Primary outcomes were symptom relief and cost-effectiveness at six months.
The researchers found that treatment success was similar in both groups (72% step –up, 70% step-down), but the average medical costs were lower for patients in the step-up group than the step-down group (€228 vs €245), mainly due to the costs of medication. The authors conclude: "Although treatment success with either step-up or step-down treatment is similar, the step-up strategy is more cost effective at 6 months for initial treatment of patients with new onset dyspeptic symptoms in primary care."
In an accompanying Comment, Dr Sander Veldhuyzen van Zanten, University of Alberta, Canada, says: "It is debatable whether the economic analysis really showed that the step-up approach was more cost effective…What do the data from DIAMOND mean for daily practice? Although interesting, the data are not likely to alter current management."
Dr Robert Laheij, Radbound University Nijmegen Medical Centre, Netherlands T) +31 6 30434295 E) r.laheij@mdl.umcn.nl / c.vanmarrewijk@antrg.umcn.nl
Dr Sander Veldhuyzen van Zanten, University of Alberta, Canada T) +1 780 407 8822 E) vanzanten@ualberta.ca
For full Article and Comment see: http://press.thelancet.com/diamond.pdf
Journal
The Lancet