The cost effectiveness of misoprostol prophylaxis alongside long term nonsteroidal anti-inflammatory drugs - Implications of the MUCOSA trial

Objective: This study considered the cost effectiveness of misoprostol prop hylaxis for nonsteroidal anti- inflammatory drug (NSAID)-induced gastrointe stinal damage, using data from the Misoprostol Ulcer Complications Outcomes Safety Assessment (MUCOSA) trial. The initial aim was to gain listing of m isoprostol on the Australian National Formulary. Design: The economic evaluation followed a 2-stage approach in considering the cost effectiveness of misoprostol, a 'within-trial' analysis followed b y a simple modelled analysis which explored the implications of the trial r esults for life-years saved beyond the trial setting. The perspective of th e evaluation is that of the healthcare system. Setting: Three different populations were considered: the total trial popul ation; patients with a history of peptic ulcer disease; and patients over 6 5 years of age. Study population: Patient data were taken from the MUCOSA trial, which invo lved 8843 patients receiving continuous NSAID therapy for the control of rh eumatoid arthritis. Interventions: Misoprostol plus any NSAID therapy was compared with placebo (no misoprostol) plus any NSAID therapy. Main outcome measures and results: The study found the incremental cost per definite serious gastrointestinal complication avoided with misoprostol wa s 39 603 Australian dollars ($A) for the total trial population, $A5599 for patients with a history of peptic ulcer disease and $A35 405 for patients over 65 years of age. The incremental cost per life-year saved with misopro stol was $A41 866 for the whole group, $A6244 for patients with a history o f peptic ulcer disease and $A40 322 for patients over 65 years of age. Conclusions: The study found misoprostol to be cost effective in this setti ng.