OBJECTIVES: To assess if acid related diseases are better managed by empiric treatment or by a diagnostic approach. METHODS: We analyzed the outcome of 182 patients with dyspepsia and/or gastro-oesophageal reflux disease (GERD) in primary care, over a period of 12 months, in the Campania region (southern Italy). Patients were divided in two groups: therapeutic group, if patients received pharmacological treat- ment since the beginning, and diagnostic group, if underwent a diagnostic approach. After 12 months the direct management costs (consultations, diagnostic procedures, drugs) were calcu- lated for both groups using National Health Service prospective (expressed in Euro 2005). We analyzed the diagnostic procedures defined as “not useful”, procedures that did not provide addi- tional information to help us decide on therapy changes, whether the prescription had been prescribed only on the basis of the symptoms (therapeutic group) or it had only been hypothesized before the diagnostic approach (diagnostic group). RESULTS: Ninety-eight patients were in therapeutic group (median age 49; Males 53%) and 84 in diagnostic group (median age 50; Males 52%). For patients in the diagnostic group there were higher management costs than for other patients (268 vs € 156/year on average). Diagnostic procedures did not modify the prescribed or hypothesized therapy and clinical management in 75% (21/28) of patients with GERD, 52% (26/50) with dyspepsia and 58% (15/26) with both GERD and dyspepsia. Based on the estimated prevalence of clinically relevant acid related diseases in Campa- nia, the cost/year of “not useful” diagnostic procedures could be of about 2.64, 4.16 and 10.73 million euros for GERD, dyspepsia and dyspepsia-GERD, respectively. CONCLUSIONS: Although the concept of “not useful” diagnostic procedure is debatable, the results of this analysis further suggest to address more attention to the improvement of education for disease management with the aim to contain health care costs

A hypothetical road mapto reduce acid related diseases costs management.

MENDITTO, ENRICA;CUOMO, ROSARIO
2008

Abstract

OBJECTIVES: To assess if acid related diseases are better managed by empiric treatment or by a diagnostic approach. METHODS: We analyzed the outcome of 182 patients with dyspepsia and/or gastro-oesophageal reflux disease (GERD) in primary care, over a period of 12 months, in the Campania region (southern Italy). Patients were divided in two groups: therapeutic group, if patients received pharmacological treat- ment since the beginning, and diagnostic group, if underwent a diagnostic approach. After 12 months the direct management costs (consultations, diagnostic procedures, drugs) were calcu- lated for both groups using National Health Service prospective (expressed in Euro 2005). We analyzed the diagnostic procedures defined as “not useful”, procedures that did not provide addi- tional information to help us decide on therapy changes, whether the prescription had been prescribed only on the basis of the symptoms (therapeutic group) or it had only been hypothesized before the diagnostic approach (diagnostic group). RESULTS: Ninety-eight patients were in therapeutic group (median age 49; Males 53%) and 84 in diagnostic group (median age 50; Males 52%). For patients in the diagnostic group there were higher management costs than for other patients (268 vs € 156/year on average). Diagnostic procedures did not modify the prescribed or hypothesized therapy and clinical management in 75% (21/28) of patients with GERD, 52% (26/50) with dyspepsia and 58% (15/26) with both GERD and dyspepsia. Based on the estimated prevalence of clinically relevant acid related diseases in Campa- nia, the cost/year of “not useful” diagnostic procedures could be of about 2.64, 4.16 and 10.73 million euros for GERD, dyspepsia and dyspepsia-GERD, respectively. CONCLUSIONS: Although the concept of “not useful” diagnostic procedure is debatable, the results of this analysis further suggest to address more attention to the improvement of education for disease management with the aim to contain health care costs
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/418437
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