MANAGEMENT OF NSAID-INDUCED GASTROPATHY - AN ECONOMIC DECISION-ANALYSIS

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a 2% to 4% annual incidence of serious gastrointestinal complica tions. These adverse clinical outcomes, and the strategies used to pre vent their occurrence, translate into a significant economic burden. A decision-analysis model was constructed to contrast the 6-month costs associated with various approaches to preventing and managing NSAID-i nduced gastropathy and to evaluate the economic impact of two treatmen t regimens using fixed-dose formulations of diclofenac/misoprostol. Af ter incorporating expected medical outcomes and predicted practice pat terns, 6-month per-patient costs were derived from the model for each of five treatment regimens: (1) NSAID alone; (2) NSAID with a histamin e(2)-receptor antagonist; (3) NSAID with coprescribed misoprostol; (4) diclofenac/misoprostol 50 mg/200 mu g TID/BID; and (5) diclofenac/mis oprostol 75 mg/200 mu g BID. The combined diclofenac/misoprostol regim ens demonstrated an 18.6% per-patient cost advantage compared with the combined NSAID regimens. Based on a 6-month period, this cost savings translated into a $214.00 per-patient overall cost savings ($1153.00 per patient for NSAID regimens versus $939.00 for diclofenac/misoprost ol regimens). The magnitude of this difference was verified by Monte C arlo simulation. Despite the considerable cost difference, sensitivity analyses revealed that our model was robust and that no single variat ion substantially influenced the results. Given the lack of long-term prospective, comparative clinical-outcomes studies in this area, this decision analysis provides guidance to clinicians in developing a rati onal and cost-effective approach to the treatment of patients requirin g chronic NSAID therapy.