PharmacoEconomics

, Volume 1, Issue 5, pp 312–324 | Cite as

Economic Costs of Functional Dyspepsia

  • Olof Nyrén
  • Greger Lindberg
  • Eva Lindström
  • Lars-Åke Marké
  • Rein Seensalu
Review Article

Summary

Dyspepsia is defined as chronic or recurrent symptoms believed to originate in the upper gastrointestinal tract. When routine investigation results in no identifiable explanation for those symptoms patients are labelled as having functional dyspepsia. In community-based surveys, approximately 30% of the otherwise apparently healthy population report dyspeptic symptoms and the majority are believed to have functional dyspepsia. Although only 1 in 4 or 5 patients make use of healthcare resources, this patient category is one of the largest in ambulatory care (1.6 to 5% of all consultations in general practice). The annual frequency of consultations for functional dyspepsia in Sweden has been estimated at 47 per 1000 population. In consequence of its high prevalence and associated absenteeism, the total costs of functional dyspepsia are considerable. In Sweden in 1981, the costs were estimated at $US55 000 per 1000 population ($US113 630 in 1991 dollars). The most cost-effective management strategy remains to be defined. Evidence is accumulating that the traditional ‘wait-and-see’ policy with initial empirical therapeutic trials without investigation may not be the most cost conserving strategy.

Keywords

Irritable Bowel Syndrome Sick Leave Dyspepsia British Medical Journal Functional Dyspepsia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adami HO, Björklund O, Enander LK, Gustavsson S, Lööf L, et al. Klinisk misstanke eller endoskopi som underlag för cimetidinterapi vid ulcus? Läkartidningen 78: 319, 1981Google Scholar
  2. Barbara L, Camilleri M, Corinaldesi R, Crean GP, Heading RC, et al. Definition and investigation of dyspepsia: consensus of an international ad hoc working party. Digestive Diseases and Sciences 34: 1272–1276, 1989PubMedCrossRefGoogle Scholar
  3. Barfred A. Pseudo-ulcer and true peptic ulcer: ten-year regional follow-up in Denmark of cases discovered by X-ray during a three-year period at Odense, Denmark; with particular consideration to behaviour patterns. Proceedings of the World Congress of Gastroenterology 10: 352–359, 1959Google Scholar
  4. Barnes RJ, Gear MW, Nicol A, Dew AB. Study of dyspepsia in a general practice as assessed by endoscopy and radiology. British Medical Journal 4: 214–216, 1974PubMedCrossRefGoogle Scholar
  5. Beavis AK, La Brooy S, Misiewicz JJ. Evaluation of one-visit endoscopic clinic for patients with dyspepsia. British Medical Journal 1: 1387–1389, 1979PubMedCrossRefGoogle Scholar
  6. Becker PU, Rygaard Olsen H, Blaasbjerg I, Elsborg L, O/igaard A. Konsekvensanalyse af ventrikelro/ntgenunderso/gelser på patienter under 40 år. Ugeskrift for Laeger 146: 2015–2017, 1984PubMedGoogle Scholar
  7. Bleijenberg G, Fennis JFM. Anamnestic and psychological features in diagnosis and prognosis of functional abdominal complaints: a prospective study. Gut 30: 1076–1081, 1989PubMedCrossRefGoogle Scholar
  8. Börsch G, Gude C. Diagnostic yield of upper gastrointestinal endoscopy in relation to age: retrospective analysis of 8,043 patients. Hepatogastroenterology 36: 113–119, 1989PubMedGoogle Scholar
  9. Brummer P, Häkkinen I. X-ray negative dyspepsia: a follow-up study. Acta Medica Scandinavica 165: 329–332, 1959PubMedCrossRefGoogle Scholar
  10. Cocco AE, Cocco DV. A survey of cimetidine prescribing. New England Journal of Medicine 304: 1281, 1981PubMedCrossRefGoogle Scholar
  11. Colin-Jones DG, Bloom B, Bodemar G, et al. Management of dyspepsia: report of a working party. Lancet 1: 576–579, 1988Google Scholar
  12. Conry BG, McLean AM, Farthing MJG. General practice and teaching hospital use of barium meal examinations in the City and Hackney health district. Postgraduate Medical Journal 62: 273–275, 1986PubMedCrossRefGoogle Scholar
  13. Conry BG, McLean AM, Farthing MJ. Diagnostic and therapeutic efficacy of barium meal examination: a prospective evaluation in general practice. British Medical Journal 299: 1443–1445, 1989PubMedCrossRefGoogle Scholar
  14. Davenport PM, Morgan AG, Darnborough A, DeDombal FT. Can preliminary screening of dyspeptic patients allow more effective use of investigational techniques? British Medical Journal 290: 217–220, 1985PubMedCrossRefGoogle Scholar
  15. Davies SWY. A year in general practice. Journal of the Royal College of General Practitioners 1: 315–329, 1958Google Scholar
  16. Dobrilla G. Functional dyspepsia: problems of classification, pathophysiology, diagnosis and therapy. In Cheli & Molinari (Eds) Pirenzepine: Knowledge and new trends, pp. 43–48, Cortina International, Verona, 1986Google Scholar
  17. Doll R, Avery Jones F, Buckatzsch MM. Occupational factors in the aetiology of gastric and duodenal ulcers, with an estimate of their incidence in the general population. Medical Research Council Special Reports, Series 276, pp. 7–96, HMSO, London, 1951Google Scholar
  18. Dotevall G, Svedlund J, Sjödin I. Symptoms in irritable bowel syndrome. Scandinavian Journal of Gastroenterology 17 (Suppl. 72): 16–19, 1982Google Scholar
  19. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care: use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 83: 529–534, 1982PubMedGoogle Scholar
  20. Edenholm M, Gustavsson R, Jansson O, Lingfors H, Nilsson O, et al. Endoscopic findings in patients with ulcer-like dyspepsia. Scandinavian Journal of Gastroenterology 20 (Suppl. 109): 163–167, 1985CrossRefGoogle Scholar
  21. Fedail SS, Araba BM, Homeida MM, Ghandour ZM. Upper gastrointestinal fibreoptic endoscopy experience in the Sudan: analysis of 2500 endoscopies. Lancet 2: 897–899, 1983PubMedCrossRefGoogle Scholar
  22. Fisher JA, Surridge JG, Vartan CP, Lohery CA. Upper gastrointestinal endoscopy — a GP service. British Medical Journal 2: 1199–1201, 1977PubMedCrossRefGoogle Scholar
  23. Forbat LN, Gribble RJ, Baron JH. Gastrointestinal endoscopy in the young. British Medical Journal 295: 365, 1987PubMedCrossRefGoogle Scholar
  24. Gear MW, Barnes RJ. Endoscopic studies of dyspepsia in a general practice. British Medical Journal 280: 1136–1137, 1980PubMedCrossRefGoogle Scholar
  25. Goodson JD, Lehmann JW, Richter JM, Read JL, Atamian S, et al. Is upper gastrointestinal radiography necessary in the initial management of uncomplicated dyspepsia?: a randomized controlled trial comparing empiric antacid therapy plus patient reassurance with traditional care. Journal of General Internal Medicine 4: 367–374, 1989PubMedCrossRefGoogle Scholar
  26. Gotthard R, Bodemar G, Brodin U, Jönsson KÅ. Treatment with cimetidine, antacid or placebo in patients with dyspepsia of unknown origin. Scandinavian Journal of Gastroenterology 23: 7–18, 1988PubMedCrossRefGoogle Scholar
  27. Gotthard R, Bodemar G, Jönsson KÅ. Diagnostic outcome in patients with dyspepsia: a preliminary report. Scandinavian Journal of Gastroenterology 22 (Suppl. 128): 86–89, 1987CrossRefGoogle Scholar
  28. Goulston KJ, Dent OF, Mant A, Logan J, Ngu M. Use of H2-receptor antagonists in patients with dyspepsia and heartburn: a cost comparison. Medical Journal of Australia 155: 20–26, 1991PubMedGoogle Scholar
  29. Haines AP, Ashleigh R, Bates R, Kreel L. The use of barium meals by general practitioners and hospital doctors. Journal of the Royal College of General Practitioners 30: 97–100, 1980PubMedGoogle Scholar
  30. Hallisey MT, Allum WH, Jewkes AJ, Ellis DJ, Fielding JWL. Early detection of gastric cancer. British Medical Journal 301: 513–515, 1990CrossRefGoogle Scholar
  31. Hallqvist J, Smedby B. Sjukvårdskonsumtion och sociala faktorer hos patienter som sökt distriktsläkare för icke-ulcus dyspepsi. Uppsala University: The Unit for Research on Primary Care and Social Service. Report 1983-08-26, Uppsala, 1983Google Scholar
  32. Hansen CL, Schreiber K, Strand L. Osofago-gastro-duodenoskopi på et blandet sygehus. Nordisk Medicin 101: 46–48, 1986PubMedGoogle Scholar
  33. Hansen JM, Bytzer P, Bondesen S, Schaffalitzky de Muckadell OB. Efficacy and outcome of an open access endoscopy service. Danish Medical Bulletin 38: 288–290, 1991PubMedGoogle Scholar
  34. Heading RC. Definitions of dyspepsia. Scandinavian Journal of Gastroenterology 26 (Suppl. 182): 1–6, 1991CrossRefGoogle Scholar
  35. Heatley RV, Rathbone BJ. Dyspepsia: a dilemma for doctors? Lancet 1: 779–782, 1987CrossRefGoogle Scholar
  36. Holdstock G, Wiseman M, Loehry CA. Open-access endoscopy service for general practitioners. British Medical Journal 1: 457–459, 1979PubMedCrossRefGoogle Scholar
  37. Hollnagel H, Norrelund N, Larsen S. Mave-tarmsymptomer blandt 40-årige i Glostrup. Ugeskrift for Laeger 144: 267–272, 1982PubMedGoogle Scholar
  38. Horrocks JC, De Dombal FT. Clinical presentation of patients with ‘dyspepsia’. Gut 19: 19–26, 1978PubMedCrossRefGoogle Scholar
  39. Järhult J, Ulgemo A. Normalt gastroskopifynd inget hinder för syrahämmande läkemedel vid dyspepsi. Läkartidningen 88: 4003–4004, 1991PubMedGoogle Scholar
  40. Johnsen R, Straume B, Forde OH. Peptic ulcer and non-ulcer dysepsia — a disease and a disorder. Scandinavian Journal of Primary Health Care 6: 239–243, 1988PubMedCrossRefGoogle Scholar
  41. Jones RH. Self-medication in a small community. Journal of the Royal College of General Practitioners 26: 410–413, 1976PubMedGoogle Scholar
  42. Jones RH. Upper gastrointestinal endoscopy — a view from general practice. Journal of the Royal College of General Pratitioners 36: 6–8, 1986Google Scholar
  43. Jones RH. Self-care and primary care of dyspepsia: a review. Family Practitioner 4: 68–77, 1987CrossRefGoogle Scholar
  44. Jones RH. What happens to patients with non-ulcer dyspepsia after endoscopy? Practitioner 232: 75–78, 1988PubMedGoogle Scholar
  45. Jones RH. Dyspeptic symptoms in the community. Gut 30: 893–898, 1989aPubMedCrossRefGoogle Scholar
  46. Jones RH. The general practitioner’s perspective of dyspepsia. In: Colin-Jones DG (Ed.) Practical approaches to the management of dyspepsia, pp. 11–13, Medicine Group, Langhorne, 1989bGoogle Scholar
  47. Jones RH, Lydeard S. Prevalence of symptoms of dyspepsia in the community. British Medical Journal 298: 30–32, 1989PubMedCrossRefGoogle Scholar
  48. Jones RHH, Lydeard SE, Hobbs FDR, Kenkre JE, Williams EI, et al. Dyspepsia in England and Scotland. Gut 31: 401–405, 1990PubMedCrossRefGoogle Scholar
  49. Kagevi I, Löfstedt S, Persson L-G. Endoscopic findings and diagnoses in unselected dyspeptic patients at a primary health care center. Scandinavian Journal of Gastroenterology 24: 145–150, 1989PubMedCrossRefGoogle Scholar
  50. Kahn K, Greenfield S. Position paper: endoscopy in the evaluation of dyspepsia. Health and Public Policy Committee, American College of Physicians, Philadelphia, Pennsylvania. Annals of Internal Medicine 102: 266–269, 1985Google Scholar
  51. Kahn KL, Greenfield S. The efficacy of endoscopy in the evaluation of dyspepsia: a review of the literature and development of a sound strategy. Journal of Clinical Gastroenterology 8: 346–358, 1986PubMedCrossRefGoogle Scholar
  52. Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet 1: 205–208, 1990CrossRefGoogle Scholar
  53. Knill-Jones RP. A formal approach to symptoms in dyspepsia. Clinics in Gastroenterology 14: 517–529, 1985PubMedGoogle Scholar
  54. Kristensen P, Sandbakken P, Johannessen T, Loge I, Hafstad PE, et al. Fordoyelsessykdommer i almenpraksis. Tidskrift for Norsk Laegeforening 105: 728–731, 1985Google Scholar
  55. Lance P, Gibson-Glubb S, Gazzard JA, Gazzard BG. Chronic dyspepsia pain in general practice — its causes and diagnosis. Postgraduate Medical Journal 61: 411–413, 1985PubMedCrossRefGoogle Scholar
  56. Levin LS. The layperson as the primary health care practitioner. Public Health Reports 91: 206–10, 1976PubMedGoogle Scholar
  57. Lindberg G. On the similarity of symptoms in peptic ulcer disease (PUD), non-ulcer dysepsia (NUD), and the irritable bowel syndrome. Digestive Diseases and Sciences 31 (October suppl): 5S, 1986CrossRefGoogle Scholar
  58. Lindberg G, Lindström E, Marké LÅ, Nordlund A, Nyrén O, et al. Gastroskopi — vid utredning av ont i magen, The Swedish Council on Technology Assessment in Health Care, Stockholm, 1990Google Scholar
  59. Lindberg G, Seensalu R, Nilsson LH, Forsell P, Kager L, et al. Transferability of a computer system for medical history taking and decision support in dyspepsia: a comparison of indicants for peptic ulcer disease. Scandinavian Journal of Gastroenterology 22 (Suppl. 128): 190–196, 1987CrossRefGoogle Scholar
  60. Lockhart SP, Schofield PM, Gribble RJ, Baron JH. Upper gastrointestinal endoscopy in the elderly. British Medical Journal 290: 283, 1985PubMedCrossRefGoogle Scholar
  61. Lööf L, Adami HO, Agenäs I, Gustavsson S, Nyberg A, et al. The diagnosis and therapy survey October 1978 — March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis. Scandinavian Journal of Gastroenterology 20 (Suppl. 109): 35–39, 1985CrossRefGoogle Scholar
  62. Mansi C, Mela GS, Pasini D, Grosso M, Corti L, et al. Patterns of dyspepsia in patients with no clinical evidence of organic diseases. Digestive Diseases and Sciences 35: 1452–1458, 1990PubMedCrossRefGoogle Scholar
  63. Marsland DW, Wood M, Mayo F. Content of family practice part I: rank order of diagnoses by frequency. Journal of Family Practice 3: 37, 1976PubMedGoogle Scholar
  64. Mollman KM, Bonnevie O, Gudmand Höyer E, Wulff HRA. A diagnostic study of patients with upper abdominal pain. Scandinavian Journal of Gastroenterology 10: 805–809, 1975Google Scholar
  65. Morell DC, Gage HG, Robinson NA. Symptoms in general practice. Journal of the Royal College of General Pratitioners 21: 32–43, 1971Google Scholar
  66. National Center for Health Statistics: The National Ambulatory Medical Care Survey (NAMCS). 1977 summary, United States, January-December, 1977 (Vital and Health Statistics Series 13: Data from the National Health Survey, no 69, DHEW publication No.[PHS] 80-1795), National Center for Health Statistics, Hyattsville, MD, 1980Google Scholar
  67. Norrelund N, Helles A, Schmiegelow M. Ukaraktäristisk dyspepsi i almen praksis: en kontrolleret undersogelse med et antacidum (Alminox®). Ugeskrift for Laeger 142: 1750–1753, 1980PubMedGoogle Scholar
  68. Nyrén O. Functional dyspepsia — a disorder of the stomach? In: Gustavsson et al. (Eds) The Stomach, pp. 385–415, Churchill Livingstone, London, 1992Google Scholar
  69. Nyrén O, Adami HO, Bates S, Bergstrom R, Gustavsson S, et al. Absence of therapeutic benefit from antacids or cimetidine in non-ulcer dyspepsia. New England Journal of Medicine 314: 339–343, 1986aPubMedCrossRefGoogle Scholar
  70. Nyrén O, Adami HO, Gustavsson S, Lindgren PG, Lööf L, et al. The ‘epigastric distress syndrome’: a possible disease entity identified by history and endoscopy in patients with nonulcer dyspepsia. Journal of Clinical Gastroenterology 9: 303–309, 1987PubMedCrossRefGoogle Scholar
  71. Nyrén O, Adami HO, Gustavsson S, Lööf L. Excess sick-listing in nonulcer dyspepsia. Journal of Clinical Gastroenterology 8: 339–345, 1986bPubMedCrossRefGoogle Scholar
  72. Nyrén O, Adami HO, Gustavsson S, Lööf L, Nyberg A. Social and economic effects of non-ulcer dyspepsia. Scandinavian Journal of Gastroenterology 20 (Suppl. 109): 41–45, 1985CrossRefGoogle Scholar
  73. Nyrén O, Nilsson F. Is gastroscopic examination of young patients worthwhile? Scandinavian Journal of Gastroenterology 17 (Suppl. 78): 27, 1982Google Scholar
  74. Petersen H, Johannessen T, Kleveland PM, Fjøsne U, Dybdahl JH, et al. Do we need to listen to the patient?: the prediction of symptoms. Scandinavian Journal of Gastroenterology 23 (Suppl. 155): 30–36, 1988CrossRefGoogle Scholar
  75. Read L, Pass TM, Komaroff AL. Diagnosis and treatment of dyspepsia: a cost-effectiveness analysis. Medical Decision Making 2: 415–438, 1982PubMedCrossRefGoogle Scholar
  76. Saunders JHB, Oliver RJ, Higson DL. Dyspepsia: incidence of non-ulcer disease in a controlled trial of ranitidine in general practice. British Medical Journal 292: 665–668, 1986PubMedCrossRefGoogle Scholar
  77. Schade RR, Donaldson RM. How physicians use cimetidine: a survey of hospitalized patients and published cases. New England Journal of Medicine 304: 1281–1284, 1981PubMedCrossRefGoogle Scholar
  78. Scheinok PA, Rinaldo Jr JA. Symptom diagnosis: optimal subsets for upper abdominal pain. Computers in Biomedical Research 1: 221–236, 1967CrossRefGoogle Scholar
  79. Sielaff F. Coincidence between chronic dyspepsia and irritable bowel syndrome. European Journal of Gastroenterology and Hepatology 2 (Suppl. 1): S105–S106, 1990Google Scholar
  80. Sloth H, Jörgensen LS. Predictors for the course of chronic non-organic upper abdominal pain. Scandinavian Journal of Gastroenterology 24: 440–444, 1989PubMedCrossRefGoogle Scholar
  81. Stene-Larsen G, Nesland A, Berstad A. Follow-up study of erosive prepyloric changes. Scandinavian Journal of Gastroenterology 24: 430–433, 1989PubMedCrossRefGoogle Scholar
  82. Swensen T, Vatn MH, Kolmannskog F, Aakhus, Gjone E. Abdominal ultrasonography in patients with uncharacteristic abdominal symptoms. Scandinavian Journal of Gastroenterology 18: 1069–1071, 1983PubMedCrossRefGoogle Scholar
  83. Talley NJ. Drug treatment of functional dyspepsia. Scandinavian Journal of Gastroenterology 26 (Suppl. 182): 47–60, 1991Google Scholar
  84. Talley NJ, Colin-Jones D, Koch KL, Koch M, Nyrén O, et al. Functional dyspepsia: a classification with guidelines for diagnosis and management. Gastroenterology International 4: 145–160, 1991aGoogle Scholar
  85. Talley NJ, McNeil D, Hayden A, Colreavy C, Piper DW. Prognosis of chronic unexplained dyspepsia: a prospective study of potential predictor variables in patients with endoscopically diagnosed nonulcer dyspepsia. Gastroenterology 92: 1060–1061, 1987PubMedGoogle Scholar
  86. Talley NJ, Phillips SF. Non-ulcer dyspepsia: potential causes and pathophysiology. Annals of Internal Medicine 108: 865–879, 1988PubMedGoogle Scholar
  87. Talley NJ, Phillips SF, Zinsmeister ARE, Melton LJ. Dyspepsia subgroups in a community: a random population-based study. American Journal of Gastroenterology 85: 1241, 1990Google Scholar
  88. Talley NJ, Piper DW. The association between non-ulcer dyspepsia and other gastrointestinal disorders. Scandinavian Journal of Gastroenterology 20: 896–900, 1985PubMedCrossRefGoogle Scholar
  89. Talley NJ, Weaver A, Zinsmeister ARE, Melton LJ. Incidence and disappearance of dyspepsia and the irritable bowel syndrome in the population. European Journal of Gastroenterology and Hepatology 3: S1, 1991bGoogle Scholar
  90. Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology 79: 283–288, 1980PubMedGoogle Scholar
  91. Tibblin G. Introduction to the epidemiology of dyspepsia. Scandinavian Journal of Gastroenterology 20 (Suppl. 109): 29–33, 1985CrossRefGoogle Scholar
  92. Vatn MH, Fausa O, Gjone E. Diagnostic value of gastrointestinal endoscopy in patients with uncharacteristic abdominal disorders. Scandinavian Journal of Gastroenterology 20: 636–640, 1985PubMedCrossRefGoogle Scholar
  93. Waldron B, Cullen PT, Kumar R, Smith D, Jankowski J, et al. Evidence for hypomotility in non-ulcer dyspepsia. Gut 32: 246–251, 1991PubMedCrossRefGoogle Scholar
  94. Warndorff DK, Knottnerus JA, Huijnen LG, Starmans R. How well do general practitioners manage dyspepsia. Journal of the Royal College of General Pratitioners 39: 499–502, 1989Google Scholar
  95. Weberg R, Berstad A. Low-dose antacids and pirenzepine in the treatment of patients with non-ulcer dyspepsia and erosive prepyloric changes: a randomized, double-blind, placebo-controlled trial. Scandinavian Journal of Gastroenterology 23: 237–243, 1988PubMedCrossRefGoogle Scholar
  96. Weir RD, Backett EM. Studies of the epidemiology of peptic ulcer in a rural community: prevalence and natural history of dyspepsia and peptic ulcer. Gut 9: 75–83, 1968PubMedCrossRefGoogle Scholar
  97. Wienbeck M, Berges W. Esophageal disorders in the etiology and pathophysiology of dyspepsia. Scandinavian Journal of Gastroenterology 20 (Suppl. 109): 133–137, 1985CrossRefGoogle Scholar
  98. Wilbur DL, Mills JH. How accurate is the diagnosis of functional indigestion?: a study of 354 cases. Annals of Internal Medicine 12: 821–829, 1938Google Scholar
  99. Williams B, Luckas M, Ellingham JHM, Dain A, Wicks ACB. Do young patients with dyspepsia need investigation? Lancet 2: 1349–1351, 1988PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1992

Authors and Affiliations

  • Olof Nyrén
    • 1
  • Greger Lindberg
    • 2
  • Eva Lindström
    • 3
  • Lars-Åke Marké
    • 4
  • Rein Seensalu
    • 2
  1. 1.Department of SurgeryUniversity HospitalUppsalaSweden
  2. 2.Department of MedicineHuddinge University HospitalHuddingeSweden
  3. 3.Department of SurgeryUniversity HospitalLinköpingSweden
  4. 4.The Swedish Council on Technology Assessment in Health CareStockholmSweden

Personalised recommendations