Cost-effectiveness of misoprostol for prophylaxis against nonsteroidal anti-inflammatory drug-induced gastrointestinal tract bleeding
J. T. Edelson, A. N. Tosteson and P. Sax
Division of General Medicine, Brigham and Women's Hospital, Boston, Mass.
Patients who take nonsteroidal anti-inflammatory drugs (NSAIDs) are at
increased risk of upper gastrointestinal tract bleeding, which may be
prevented with prophylactic prescription of misoprostol. Using data from
the literature, we estimated rates of gastrointestinal tract bleeding in
NSAID users, direct medical costs, years of life lost, and
cost-effectiveness of a 1-year course of misoprostol in three clinical
populations of NSAID users: all users, users aged 60 years or older, and
users with rheumatoid arthritis. The incremental cost-effectiveness ratios
for misoprostol as primary prevention were $667,400 per year of life saved
for all NSAID users; $186,700 per year of life saved for users aged 60
years or older; and $95,600 per year of life saved for users with
rheumatoid arthritis. Misoprostol as secondary prevention for those who
continued to take NSAIDs despite having had an episode of gastrointestinal
tract bleeding in the previous year was associated with incremental
cost-effectiveness ratios less than $40,000 per year of life saved in all
patient groups. We conclude that misoprostol is costly as primary
prevention for NSAID-induced gastrointestinal tract bleeding in the groups
examined but may be cost-effective as secondary prevention in patients with
a proved history of gastrointestinal tract bleeding.
Analysis of Aspirin-Associated Risks in Healthy Individuals
Hur et al.
The Annals of Pharmacotherapy 2005;39:51-57.
ABSTRACT
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Cost-Effectiveness of Aspirin Chemoprevention for Barrett's Esophagus
Hur et al.
JNCI J Natl Cancer Inst 2004;96:316-325.
ABSTRACT
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Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease
Gaspoz et al.
NEJM 2002;346:1800-1806.
ABSTRACT
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Cost-effectiveness of New Antiplatelet Regimens Used as Secondary Prevention of Stroke or Transient Ischemic Attack
Sarasin et al.
Arch Intern Med 2000;160:2773-2778.
ABSTRACT
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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
van Dieten et al.
Ann Rheum Dis 2000;59:753-759.
ABSTRACT
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Evaluating Drugs after Their Approval for Clinical Use
Ray et al.
NEJM 1993;329:2029-2032.
FULL TEXT
MISOPROSTOL COST-EFFECTIVE FOR SECONDARY PREVENTION OF BLEEDING FROM NSAIDS
JWatch General 1990;1990:6-6.
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