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Sanford H. Roth, MD
Arthritis Center, Ltd Phoenix, Ariz

JAMA. 1991;265(5):593-594.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

In the July 4,1990, issue of JAMA, Edelson et al¹ presented a mc del regarding the cost-effectiveness of misoprostol (Cytotec) as either primary or secondary prophylaxis against NSAID-induced gastrointestinal tract bleeding. Their model, however, may no properly reflect present clinical and pu blic health concerns.

For example, by limiting the construct to bleeding and death alone and the direct medical costs associated with those se outcomes, the authors ignore nonbleeding active ulcers, which play a large role in NSAID-induced clinical problems.² Such nonbleeding ulcers cause lost work time and earnings, direct and indirect medical costs, and suffering, from both the ulcer episode and th( inability to use NSAIDs to relieve pain and improve functioning.⁴ Hence, the model would be strengthened by examining cost per ulcer avoided rather than cost per YOLS, which has an inherent bias against middle-aged and older adults.

If, as . . . [Full Text PDF of this Article]

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