The cost‐effectiveness of misoprostol for nonsteroidal antiinflammatory drug–associated adverse gastrointestinal events

Sherine E. Gabriel, R. Liisa Jaakkimainen, Claire Bombardier

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

Objective. To compare, in a Canadian health care setting, the costs and consequences of 3 strategies of misoprostol prophylaxis for osteoarthritis patients: prophylaxis for all patients taking nonsteroidal antiinflammatory drugs (NSAIDs), for no patients taking NSAIDs, and for only elderly patients (age ≥60) taking NSAIDs. Methods. We designed a decision‐analysis model which incorporated costs (estimated with ulcer patient profiles and medical records), review, and probabilities (estimated from a companion metaanalysis, selected literature review, and Ontario Ministry of Health Statistics). Effectiveness was defined as the number of episodes of gastric ulceration requiring hospitalization or outpatient management that were averted by each strategy. Results. On average, prophylaxis cost an additional $650 for every additional gastrointestinal event prevented. Prophylaxis for elderly NSAID users was cost saving if the ulcer complication rate in this group exceeds 1.2%, or if either the charges for outpatient ulcer treatment exceed $2,000, or the 3‐month price of misoprostol is ≤90. Conclusion. Our results demonstrate that, in this setting, misoprostol prophylaxis may be highly cost effective.

Original languageEnglish (US)
Pages (from-to)447-459
Number of pages13
JournalArthritis & Rheumatism
Volume36
Issue number4
DOIs
StatePublished - Apr 1993

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Pharmacology (medical)

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