managing these patients. However, most patients have no major abnormalities on OGD, and a number of different strategies have been suggested for management. Definitive trial evidence from primary care is still several years away, but primary care physicians need guidance now. Aims: This project aimed to construct a cost-effectiveness model for the management of dyspepsia in primary care using Discrete Event Simulation (DES). Methods: Unlike decision analysis or Markov models, DES allows accurate prediction of costs and outcomes for individual patients over long periods of time. In DES, patients flow between a series of health states and the costs and diagnostic events accruing can be recorded and analysed. Different patients follow different paths through the model with probabilities which depend upon the input parameters and the choice of strategy. Uncertainties in the data can be explored by sensitivity analysis. The model was programmed in Visual Basic for Windows. 20 000 patients were simulated with costs and outcomes followed over 5 years from each initial consultation. Effectiveness was measured in dyspepsia free months, mean cost-effectiveness ratios and incremental cost-effectiveness ratios (leER) were calculated. Results: All strategies involving endoscopy were dominated. Cost-effective strategies were those involving acid-suppression therapy alone, or after initial testing and eradication of Hipylori. Eradicating Hipylori cost 62 ($102) per additional month dyspepsia free over 5 years.
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Froehlich et al. (2000) studied this question.