18 jan 2009--Starting patients with dyspepsia on antacids and then progressing stepwise to more expensive therapies seems more cost effective than reversing the sequence, according to a Lancet study, but a commentator disagrees.
Researchers randomized some 650 patients with new-onset dyspepsia to one of two treatment sequences: the "step up" arm started with antacids, then H2-receptor antagonists, then proton-pump inhibitors; the "step down" arm used the same treatments but in reverse order. Each step lasted 4 weeks, and patients proceeded to the next step only if symptoms persisted or relapsed.
By 6 months after entry, both groups had achieved equal measures (roughly 70%) of adequate symptom relief , but average costs were lower in the step-up group.
A commentator, citing flaws in the study's design (e.g., the paucity of information gathered that would allow estimates of true effect size) says the work is "not likely to alter current management."