Article type
Year
Abstract
Introduction/Objective: The objectives were:- to develop a national disease core model to aid in the evaluation of different management strategies for peptic ulcer disease including eradication of H. pylori; to provide the facility to tailor the model to local and specific populations and service characteristics and thus provide support to the development and implementation of local and cost effective clinical practice guidelines.
Methods: A range of management strategies for the treatment of peptic ulcer within dyspepsia were identified through literature searches and review with primary and secondary care clinicians. A model of the patient pathways was developed and literature searches were undertaken to populate the model. The literature searches covered areas such as peptic ulcer epidemiology, H. pylori eradication regimens, acid suppressant regimens, associated health resource usage and cost data.
Results: The model treats the prevalent and incident peptic ulcer populations separately and profiles outcomes in terms of health, resource usage and costs. For the prevalence population of known ulcer patients the model predicts an average cost per patient of approximately 360 pounds when generic cimitedine is used as the long term acid suppressant over a ten year horizon. Where a range of generics and proprietary H2 receptors and proton pump inhibitors are prescribed for a population the costs may rise significantly. A sample prescribing profile resulted in a cost per patient of around 860 pounds. The eradication of H. pylori can result in significant health benefits together with a reduction in cost per patient to approximately 160 pounds.
Discussion: The article 'Implementing Clinical Practice Guidelines, Effective Health Care Bulletin 1994 Dec: No 8." suggests that guidelines should be based on, and explicitly linked to, reliable evidence of clinical and cost effectiveness; should be local and should be disseminated through active educational intervention. The default parameters in the model are based on the best available current literature and all sources are referenced within the body of the model. The model can be used to focus discussions between local policy makers and clinicians in the light of specific local population and treatment characteristics. The model thereby serves to identify and generate consensus support for cost effective clinical guidelines. The model is about to be piloted in both a district health authority and a GP commissioning body.
Methods: A range of management strategies for the treatment of peptic ulcer within dyspepsia were identified through literature searches and review with primary and secondary care clinicians. A model of the patient pathways was developed and literature searches were undertaken to populate the model. The literature searches covered areas such as peptic ulcer epidemiology, H. pylori eradication regimens, acid suppressant regimens, associated health resource usage and cost data.
Results: The model treats the prevalent and incident peptic ulcer populations separately and profiles outcomes in terms of health, resource usage and costs. For the prevalence population of known ulcer patients the model predicts an average cost per patient of approximately 360 pounds when generic cimitedine is used as the long term acid suppressant over a ten year horizon. Where a range of generics and proprietary H2 receptors and proton pump inhibitors are prescribed for a population the costs may rise significantly. A sample prescribing profile resulted in a cost per patient of around 860 pounds. The eradication of H. pylori can result in significant health benefits together with a reduction in cost per patient to approximately 160 pounds.
Discussion: The article 'Implementing Clinical Practice Guidelines, Effective Health Care Bulletin 1994 Dec: No 8." suggests that guidelines should be based on, and explicitly linked to, reliable evidence of clinical and cost effectiveness; should be local and should be disseminated through active educational intervention. The default parameters in the model are based on the best available current literature and all sources are referenced within the body of the model. The model can be used to focus discussions between local policy makers and clinicians in the light of specific local population and treatment characteristics. The model thereby serves to identify and generate consensus support for cost effective clinical guidelines. The model is about to be piloted in both a district health authority and a GP commissioning body.