Systematic review of the cost effectiveness of prophylactic treatments in the prevention of gastropathy in patients with rheumatoid arthritis or osteoarthritis taking non-steroidal anti-inflammatory drugs

A systematic review on the cost effectiveness of prophylactic treatments of nonsteroidal anti-inflammatory drug (NSAID) induced gastropathy in patient s with osteoarthritis or rheumatoid arthritis was conducted. Two reviewers conducted the literature search and the review. Both full and partial econo mic evaluations published in English, Dutch, or German were included. The c riteria list published in the textbook of Drummond was used to determine th e quality of the economic evaluations. The methodological quality of three randomised controlled trials (RCTs) in which the economic evaluations obtai ned probability estimates of NSAID induced gastropathy and adverse events w as assessed by a list of internal validity criteria. The conclusions were b ased on a rating system consisting of four levels of evidence. Ten economic evaluations were included; three were based on RCTs. All evalu ations studied misoprostol as prophylactic treatment: in one evaluation mis oprostol was studied as a fixed component in a combination with diclofenac (Arthrotec). All economic evaluations comprised analytical studies containi ng a decision tree. The three trials were of high methodological quality. N ine economic evaluations were considered high quality and one economic eval uation was considered of low methodological quality. There is strong eviden ce (level "A") that the use of misoprostol for the prevention of NSAID indu ced gastropathy is cost effective, and limited evidence (level "C") that th e use of Arthrotec is cost effective. Although the levels of evidence used in this review are arbitrary, it is believed that a qualitative analysis is useful: quantitative analyses in this field are hampered by the heterogene ity of economic evaluations. Existing criteria to evaluate the methodologic al quality of economic evaluations may need refinement for use in systemati c reviews.