THE COST-EFFECTIVENESS OF DICLOFENAC PLUS MISOPROSTOL COMPARED WITH DICLOFENAC MONOTHERAPY IN PATIENTS WITH RHEUMATOID-ARTHRITIS

The objective of our study was to estimate the cost effectiveness of t reatment with a fixed-dose combination of diclofenac and misoprostol c ompared with diclofenac monotherapy in the prevention of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers in rheumatoid arthritis (RA) patients. A model was used to incorporate estimates of costs, inc idence of ulcers and their complications, death rates and the efficacy of misoprostol. The costs per ulcer-free period gained and costs per additional survivor were calculated. Cost effectiveness was calculated for the treatment of all RA patients, and of risk groups only. All co sts were measured in 1995 Netherlands guilders (NLG; exchange rate at the time of the study: NLG1 = $US0.60). The analysis showed that if 10 0 RA patients receive 3 months of treatment with diclofenac plus misop rostol, instead of diclofenac alone, this will lead to overall additio nal costs of NLG773, while 0.82 symptomatic ulcers and 0.019 deaths wi ll be prevented. If misoprostol is given only to patients at high risk for NSAID-induced ulcer, cost savings will occur instead of additiona l costs. Univaririte sensitivity analysis showed that the outcomes are sensitive to changes in: (i) the percentage of ulcers treated in the ambulatory setting; (ii) the price difference between diclofenac and t he fixed-dose diclofenac-misoprostol combination; (iii) the percentage of ulcers with complications; and (iv) the efficacy of misoprostol. I n conclusion, it can be stated that treatment with diclofenac-misopros tol is cost saving in RA patients at high risk for NSAID-induced ulcer s. For RA patients in general, the cost-effectiveness of this interven tion compares favourably with that of other prophylactic treatments.