Evaluation of dyspepsia and functional gastrointestinal disorders: a cost-benefit analysis of different approaches

Abstract

Objective: To establish a decision rule for diagnostic testing in patients with dyspepsia.

Design: Medical decision analysis using a decision-tree model.

Methods: Costs and benefits associated with two alternative strategies are compared. In the first strategy, empirical therapy alone is provided. The second strategy also includes tests to diagnose the cause of dyspepsia.

Results: It is more beneficial to test than to employ empirical treatment alone if the a-priori probability P of an organic disease is larger than the ratio of the costs T of testing to the costs C of a missed diagnosis: P > T/C. In most clinical situations, the costs of a missed diagnosis outweigh the costs of testing by a factor of 5-10, for which the cost ratio is 10-20%.

Conclusion: Diagnostic tests should be performed in patients with dyspepsia, whenever the probability of finding organic disease exceeds the ratio of the cost of testing to the cost of missing this diagnosis.