THE COST-EFFECTIVENESS OF MISOPROSTOL IN PREVENTING SERIOUS GASTROINTESTINAL EVENTS ASSOCIATED WITH THE USE OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Objective. To reexamine the cost-effectiveness of misoprostol, using d ata from a recently published placebo-controlled trial of misoprostol in >8,000 patients with rheumatoid arthritis (RA) taking nonsteroidal antiinflammatory drugs (the Misoprostol Ulcer Complications Outcome Sa fety Assessment [MUCOSA] study).Methods. Actual clinical events and th e rates of endoscopies and upper gastrointestinal (GI) radiographic se ries, hospitalizations, and surgery for these events were derived from the MUCOSA study and used in a decision analysis. Estimates of costs for the management of these events were derived from the Ontario Case Cost Project database and published economic evaluations; cases were a djusted to 1994 Canadian dollars. Incremental cost-effectiveness (from the viewpoint of the provincial health care plan in Canada) was calcu lated for the original trial population (risk of a serious GI complica tion 1%) and for the subsets of patients with medium (3%) and high (6% ) risk. Results. For the original study population, averting 1 serious GI complication by prescribing misoprostol would cost an additional $ 94,766 (Canadian; range $60,266-137,146). For patients with previous p eptic ulcer disease (medium risk), the cost would be $14,943 (range $1 0,912-32,157), and for patients with previous peptic ulcer disease and age >75 (high risk), the cost would be $4,101 (range $-220 to $18,146 ). Conclusion. Prescribing misoprostol for all patients with RA who ar e greater than or equal to 52 years old costs $94,766 for each additio nal GI event averted. However, when patients at higher risk are specif ically selected, the cost per averted GI complication is markedly redu ced. These results, based on actual serious event rates and actual dat a on endoscopies and upper GI series, hospitalizations, and surgeries, provide a better estimate of the true cost-effectiveness of misoprost ol than previous analyses based on endoscopic data and modeling of all resource utilizations.