The cost of treating stomach complaints can be reduced if patients who develop stomach complaints for the first time are started on mild forms of medication, and only changed to stronger medication if their symptoms continue. This has been shown in a study by the Radboud University Nijmegen Medical Center in collaboration with the University Medical Center (UMC) Utrecht and the University of Maastricht, which was published this week in the medical journal The Lancet.
Guideline
Approximately forty percent of the Dutch population regularly complain of stomach problems. The Dutch Institute for Healthcare Improvement (CBO) has compiled a guideline on the treatment of these problems. This guideline advises general practitioners who treat patients complaining of stomach problems for the first time, to initially prescribe milder medications (simple acid binders and acid inhibitors), and if these do not have a satisfactory result, only then to change to strong proton pump inhibitors. This is known as “step-up” treatment. In practice, patients are often given the strongest medications straight away. Up to now, the best method of treatment in terms of cost-effectiveness, has been unclear.
In 2003, the Radboud University Nijmegen Medical Center, the University Medical Center (UMC) Utrecht, and the University of Maastricht, began a large scale study which compared step-up with step-down treatment: from strong to milder. More than 300 general practitioners and 664 patients took part in this study.
The results have shown that those patients who began on the strongest medications were symptom-free before those patients who began on milder medication. However, after six months the differences between these groups had almost disappeared (step-up: seventy-two percent symptom-free, step-down: seventy percent). Neither was there any difference in quality of life after six months.
However, patients who began on the milder medication had notably lower treatment costs, particularly for medications. This result indicates that, particularly in view of the cost, it is socially more desirable for general practitioners to begin by prescribing milder medication to patients who complain of stomach problems for the first time. This is in accordance with the CBO guideline on stomach complaints.
Proviso
Pantoprazole, a comparatively expensive type of proton pump inhibitor, was used in this study. In practice, this drug is prescribed relatively frequently. If, in the calculation, pantoprazole is replaced by one of the cheaper proton pump inhibitors, then the difference in the cost of treatment is almost negligible. It is not known if these cheaper proton pump inhibitors are equally as effective as pantoprazole.