Elsevier

Clinical Therapeutics

Volume 19, Issue 6, November–December 1997, Pages 1496-1509
Clinical Therapeutics

Pharmaceutical Economics & Health Policy
Management of NSAID-induced gastropathy: an economic decision analysis

https://doi.org/10.1016/S0149-2918(97)80021-5Get rights and content

Abstract

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a 2% to 4% annual incidence of serious gastrointestinal complications. These adverse clinical outcomes, and the strategies used to prevent their occurrence, translate into a significant economic burden. A decision-analysis model was constructed to contrast the 6-month costs associated with various approaches to preventing and managing NSAID-induced gastropathy and to evaluate the economic impact of two treatment regimens using fixed-dose formulations of diclofenac/misoprostol. After incorporating expected medical outcomes and predicted practice patterns, 6-month per-patient costs were derived from the model for each of five treatment regimens: (1) NSAID alone; (2) NSAID with a histamine2-receptor antagonist; (3) NSAID with coprescribed misoprostol; (4) diclofenac/misoprostol 50 mg/200 μg TID/BID; and (5) diclofenac/misoprostol 75 mg/200 μg BID. The combined diclofenac/misoprostol regimens demonstrated an 18.6% per-patient cost advantage compared with the combined NSAID regimens. Based on a 6-month period, this cost savings translated into a $214.00 per-patient overall cost savings ($1153.00 per patient for NSAID regimens versus $939.00 for diclofenac/misoprostol regimens). The magnitude of this difference was verified by Monte Carlo simulation. Despite the considerable cost difference, sensitivity analyses revealed that our model was robust and that no single variation substantially influenced the results. Given the lack of long-term prospective, comparative clinical-outcomes studies in this area, this decision analysis provides guidance to clinicians in developing a rational and cost-effective approach to the treatment of patients requiring chronic NSAID therapy.

References (45)

  • G Singh et al.

    Gastrointestinal tract complications of nonsteroidal anti-inflammatory drug treatment in rheumatoid arthritis. A prospective observational cohort study

    Arch Intern Med

    (1996)
  • DJ Bjorkman

    Nonsteroidal anti-inflammatory drug-induced gastrointestinal injury

    Am J Med

    (1996)
  • FDA's NSAID class labeling estimate of 4–6% GI adverse reaction annually is not valid, PMA maintains: PMA proposes industry-consensus NSAID label warning

    FDA Reports

    (301987)
  • J Fries

    Toward an understanding of NSAID-related adverse events: The contribution of longitudinal data

    Scand J Rheumatol

    (1996)
  • BJ Kendall et al.

    NSAID-associated gastrointestinal damage and the elderly

    Pract Gastroenterol

    (1993)
  • JF Fries

    Assessing and understanding patient risk

    Scand J Rheumatol

    (1992)
  • FE Silverstein et al.

    Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving non-steroidal anti-inflammatory drugs

    Ann Intern Med

    (1995)
  • G Bianchi Porro et al.

    Double-blind, double-dummy endoscopic comparison of the mucosal protective effects of misoprostol versus ranitidine on naproxen-induced mucosal injury to the stomach and duodenum in rheumatic patients

    Am J Gastroenterol

    (1997)
  • JB Raskin et al.

    Misoprostol and ranitidine in the prevention of NSAID-induced ulcers: A prospective, double-blind, multicenter study

    Am J Gastroenterol

    (1996)
  • Drug Utilization Evaluation of Michigan Medicaid claims database (12/1/94–11/30/95)

    (1995)
  • M Koch et al.

    Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. A meta-analysis of randomized controlled clinical trials

    Arch Intern Med

    (1996)
  • RSB Ehsanullah et al.

    Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: Controlled trial of ranitidine

    BMJ

    (1988)
  • Cited by (0)

    View full text