Gastroprotective Strategies in Chronic NSAID Users- A Cost-Effectiveness Analysis Comparing Single-Tablet Formulations with Individual Components

Jul 1, 2013, 00:00
10.1016/j.jval.2013.05.002
https://www.valueinhealthjournal.com/article/S1098-3015(13)01818-4/fulltext
Title : Gastroprotective Strategies in Chronic NSAID Users- A Cost-Effectiveness Analysis Comparing Single-Tablet Formulations with Individual Components
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(13)01818-4&doi=10.1016/j.jval.2013.05.002
First page : 769
Section Title : Economic Evaluation
Open access? : No
Section Order : 8

Objectives

To evaluate the cost-effectiveness of competing gastroprotective strategies, including single-tablet formulations, in the prevention of gastrointestinal (GI) complications in patients with chronic arthritis taking nonsteroidal anti-inflammatory drugs (NSAIDs).

Methods

We performed a cost-utility analysis to compare eight gastroprotective strategies including NSAIDs, cyclooxygenase-2 inhibitors, proton pump inhibitors (PPIs), histamine-2 receptor antagonists, misoprostol, and single-tablet formulations. We derived estimates for outcomes and costs from medical literature. The primary outcome was incremental cost per quality-adjusted life-year gained. We performed sensitivity analyses to assess the effect of GI complications, compliance rates, and drug costs.

Results

For average-risk patients, NSAID + PPI cotherapy was most cost-effective. The NSAID/PPI single-tablet formulation became cost-effective only when its price decreased from €0.78 to €0.56 per tablet, or when PPI compliance fell below 51% in the NSAID + PPI strategy. All other strategies were more costly and less effective. The model was highly sensitive to the GI complication risk, costs of PPI and NSAID/PPI single-tablet formulation, and compliance to PPI. In patients with a threefold higher risk of GI complications, both NSAID + PPI cotherapy and single-tablet formulation were cost-effective.

Conclusions

NSAID + PPI cotherapy is the most cost-effective strategy in all patients with chronic arthritis irrespective of their risk for GI complications. For patients with increased GI risk, the NSAID/PPI single-tablet formulation is also cost-effective.

Categories :
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Gastrointestinal Disorders
  • Musculoskeletal Disorders
  • Specific Diseases & Conditions
Tags :
  • compliance
  • cost-effectiveness
  • cost-utility
  • dyspepsia
  • gastrointestinal bleeding
  • nonsteroidal anti-inflammatory drugs
  • proton pump inhibitors
Regions :
  • Global
ViH Article Tags :