Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug—Induced Gastropathy in Patients With Chronic Arthritis?

Stucki, Gerold

doi:10.1001/archinte.1994.00420180022003

Cited by 35 publications

(10 citation statements)

References 23 publications

(68 reference statements)

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“…[16] The risk reduction of 0.38 percentage units over 6 months is much lower than the risk reduction assumed by Edelson and Tosteson (2.3 percentage units for a 3-month period). [14) Even in patients with rheumatoid arthritis and a history of peptic ulcer, the risk reduction was only 2 percentage units (i.e.…”

Section: Assumptions About the Reduction In Gi Eventsmentioning

confidence: 76%

“…Economic evaluations of misoprostol prophylaxis for nonsteroidal anti-inflammatory drug-induced gastric ulcer in patients with arthritic conditions (reproduced from Stucki et al, [16] controversial whether the savings from preventing the adverse effects of NSAIDs exceed the cost of using misoprostol. [5,[11][12][13][14][15][16][17][18][19] It is also debated whether the gain in quality of life from avoidance of rare NSAID-induced gastrointestinal complications exceeds the disutility from misoprostol use and the diarrhoea which it may cause. [5,6) If misoprostol prophylaxis is to lead to net costs and a net gain in quality of life, it needs to be determined whether the benefits exceed the costS.…”

Section: The Problemmentioning

confidence: 99%

“…[16,19) Thus, for the general population of NSAID users, the cost of misoprostol prophylaxis does not seem to exceed the savings from reducing the cost of NSAID complications. The elderly have a considerably increased risk of NSAID toxicity compared with younger patients)4,23) Particularly in the presence ofless established risk factors such as comorbid illnesses, alcohol (ethanol) use, smoking and steroid therapy, misoprostol prophylaxis may be cost saving.…”

Section: Stucki Et Almentioning

confidence: 99%

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Use of Misoprostol in the Elderly

1996

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Misoprostol is a prostaglandin E1 analogue which reduces both gastric ulcerations and clinically important bleeding in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). Economic evaluations of prophylactic use of misoprostol with NSAIDs differ in their conclusions mainly because of different assumptions regarding the absolute risk reduction of symptomatic ulcers. Assuming a conservative estimate of the absolute risk reduction based on new effectiveness data, all studies would have concluded that misoprostol prophylaxis results in net costs in the general population of NSAID users. However, in the elderly with a clearly increased risk of gastrointestinal (GI) lesions and ulcer complications, and an increased hospitalisation rate, misoprostol may be cost saving. Also, in the elderly the gain in quality of life seems to offset the uncertain reduction in quality of life due to the adverse effects of misoprostol. However, the suggestion that misoprostol prophylaxis in the elderly is cost effective or cost saving needs to be confirmed in further studies.

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Section: Assumptions About the Reduction In Gi Eventsmentioning

confidence: 76%

Section: The Problemmentioning

confidence: 99%

Section: Stucki Et Almentioning

confidence: 99%

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Use of Misoprostol in the Elderly

1996

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“…31 The previously conducted reviews on this subject only searched Medline,7 8 or the database in which the economic evaluations were found was not mentioned 910 The number of economic evaluations included in these reviews ranged from five to eight, whereas we identified 10 economic evaluations.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the cost effectiveness of prophylactic treatments in the prevention of gastropathy in patients with rheumatoid arthritis or osteoarthritis taking non-steroidal anti-inflammatory drugs

Dieten

Bos

Tulder

et al. 2000

Annals of the Rheumatic Diseases

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A systematic review on the cost effectiveness of prophylactic treatments of non-steroidal anti-inflammatory drug (NSAID) induced gastropathy in patients with osteoarthritis or rheumatoid arthritis was conducted. Two reviewers conducted the literature search and the review. Both full and partial economic evaluations published in English, Dutch, or German were included. The criteria list published in the textbook of Drummond was used to determine the quality of the economic evaluations. The methodological quality of three randomised controlled trials (RCTs) in which the economic evaluations obtained probability estimates of NSAID induced gastropathy and adverse events was assessed by a list of internal validity criteria. The conclusions were based on a rating system consisting of four levels of evidence. Ten economic evaluations were included; three were based on RCTs. All evaluations studied misoprostol as prophylactic treatment: in one evaluation misoprostol was studied as a fixed component in a combination with diclofenac (Arthrotec). All economic evaluations comprised analytical studies containing a decision tree. The three trials were of high methodological quality. Nine economic evaluations were considered high quality and one economic evaluation was considered of low methodological quality. There is strong evidence (level "A") that the use of misoprostol for the prevention of NSAID induced gastropathy is cost effective, and limited evidence (level "C") that the use of Arthrotec is cost effective. Although the levels of evidence used in this review are arbitrary, it is believed that a qualitative analysis is useful: quantitative analyses in this field are hampered by the heterogeneity of economic evaluations. Existing criteria to evaluate the methodological quality of economic evaluations may need refinement for use in systematic reviews.

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“…92 Four of the analyses retrieved concerned use of misoprostol by patients with osteoarthritis [93][94][95][96] and one concerned use by patients with rheumatoid arthritis. 97 A crossnational comparison study was also retrieved.…”

Section: Modelling the Cost-effectiveness Of Misoprostol Prophylaxismentioning

confidence: 99%

How to develop cost-conscious guidelines

Eccles

Mason

2001

Health Technol Assess

165

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Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug—Induced Gastropathy in Patients With Chronic Arthritis?

Cited by 35 publications

References 23 publications

Use of Misoprostol in the Elderly

Use of Misoprostol in the Elderly

Systematic review of the cost effectiveness of prophylactic treatments in the prevention of gastropathy in patients with rheumatoid arthritis or osteoarthritis taking non-steroidal anti-inflammatory drugs

How to develop cost-conscious guidelines

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