P J Davey1, E Meyer. 1. M-TAG Pty Ltd, Chatswood, New South Wales, Australia.
Abstract
OBJECTIVE: This study considered the cost effectiveness of misoprostol prophylaxis for nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal damage, using data from the Misoprostol Ulcer Complications Outcomes Safety Assessment (MUCOSA) trial. The initial aim was to gain listing of misoprostol on the Australian National Formulary. DESIGN: The economic evaluation followed a 2-stage approach in considering the cost effectiveness of misoprostol, a 'within-trial' analysis followed by a simple modelled analysis which explored the implications of the trial results for life-years saved beyond the trial setting. The perspective of the evaluation is that of the healthcare system. SETTING:Three different populations were considered: the total trial population; patients with a history of peptic ulcer disease; and patients over 65 years of age. STUDY POPULATION: Patient data were taken from the MUCOSA trial, which involved 8843 patients receivingcontinuous NSAID therapy for the control of rheumatoid arthritis. INTERVENTIONS:Misoprostol plus any NSAID therapy was compared with placebo (no misoprostol) plus any NSAID therapy. MAIN OUTCOME MEASURES AND RESULTS: The study found the incremental cost per definite serious gastrointestinal complication avoided with misoprostol was 39,603 Australian dollars ($A) for the total trial population, $A5599 for patients with a history of peptic ulcer disease and $A35,405 for patients over 65 years of age. The incremental cost per life-year saved with misoprostol was $A41,866 for the whole group, $A6244 for patients with a history of peptic ulcer disease and $A40,322 for patients over 65 years of age. CONCLUSIONS: The study found misoprostol to be cost effective in this setting.
RCT Entities:
OBJECTIVE: This study considered the cost effectiveness of misoprostol prophylaxis for nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal damage, using data from the MisoprostolUlcer Complications Outcomes Safety Assessment (MUCOSA) trial. The initial aim was to gain listing of misoprostol on the Australian National Formulary. DESIGN: The economic evaluation followed a 2-stage approach in considering the cost effectiveness of misoprostol, a 'within-trial' analysis followed by a simple modelled analysis which explored the implications of the trial results for life-years saved beyond the trial setting. The perspective of the evaluation is that of the healthcare system. SETTING: Three different populations were considered: the total trial population; patients with a history of peptic ulcer disease; and patients over 65 years of age. STUDY POPULATION: Patient data were taken from the MUCOSA trial, which involved 8843 patients receiving continuous NSAID therapy for the control of rheumatoid arthritis. INTERVENTIONS:Misoprostol plus any NSAID therapy was compared with placebo (no misoprostol) plus any NSAID therapy. MAIN OUTCOME MEASURES AND RESULTS: The study found the incremental cost per definite serious gastrointestinal complication avoided with misoprostol was 39,603 Australian dollars ($A) for the total trial population, $A5599 for patients with a history of peptic ulcer disease and $A35,405 for patients over 65 years of age. The incremental cost per life-year saved with misoprostol was $A41,866 for the whole group, $A6244 for patients with a history of peptic ulcer disease and $A40,322 for patients over 65 years of age. CONCLUSIONS: The study found misoprostol to be cost effective in this setting.