Cost-effectiveness analysis of oral N-acetylcysteine as a preventive treatment in chronic bronchitis

Chronic bronchitis has a prevalence of approximately 11% in the population aged over 35 years and its frequent acute exacerbations (AECBs) are an impo rtant cause of morbidity and costs in health-care resources. Oral N-acetylc ysteine (NAC) is administered during the winter months as a way of reducing AECBs. This cost-effectiveness analysis was done from the payers' point of view in the Swiss health-care system, based on a retrospective analysis of published placebo-controlled studies. The pooled data show that continuous administration of 400 mg day(-1) per os of NAC leads to a significant redu ction in the number of AECBs (NAC: 16.2 vs 25.2% AECBs per month); a signif icantly smaller percentage of days of sick leave (NAC: 3.6 us 5.3%) and a l ower rate of hospitalizations (NAC: 1.5 vs 3.5% over a period of 6 months). Taking into account the poor compliance of these patients, calculations as sumed a compliance of 80%. Direct costs were those of an NAC treatment, the management of an AECB (biological tests in 59%, X-rays in 65% and pulmonar y function tests in 45%; antibiotics 70%, bronchodilators in 89%, corticost eroids in 24% and 'others' in 25% of the patients), and of hospitalizations (estimated at 10 days per case). Based on these figures, the mean direct c osts of an untreated patient were CHF 869 us CHF 700 in the NAG-treated pat ient. Univariate sensitivity analysis indicated that cost neutrality is rea ched with 0.6 (< 0.25-1.94, 95% CI) AECBs per 6 months. Indirect costs (bas ed on sick leave) were also significantly different; the mean in untreated patients was CHF 1324 vs CHF 779 in the NAG-treated patients. Conclusion: T reating chronic bronchitis patients with NAC during the winter months is co st-effective both from the payer's and a social point of view. (C) 2000 Aca demic Press.