A cost-utility analysis of misoprostol prophylaxis for rheumatoid arthritis patients receiving nonsteroidal antiinflammatory drugs.
OBJECTIVE
To determine the cost-utility of low-dose misoprostol prophylaxis in rheumatoid arthritis (RA) patients treated with nonsteroidal antiinflammatory drugs (NSAIDs).


METHODS
Prospectively collected, population-based data on 57 RA patients' preferences (obtained using the category scaling and time trade-off techniques), charge data from a consecutive, population-based cohort of 36 RA patients with NSAID-related gastric ulcer, and literature-derived probability estimates were incorporated into a decision analysis model.


RESULTS
Probabilistic sensitivity analysis using 10,000 Monte Carlo simulations demonstrated that, on average, prophylaxis resulted in modest additional costs and no additional quality-of-life benefits. At best, the incremental cost per quality-adjusted life year gained was $9,333. At worst, prophylaxis reduced quality of life. Prophylaxis was cost-saving if the ulcer complication rate was > 1.5%, or if the 3-month price of misoprostol was < or = $95.


CONCLUSIONS
Whereas prophylaxis may be cost-saving among high-risk NSAID users, from some patients' perspective, it reduces quality of life. Although these data may not be generalizable to other clinical populations, they illustrate the importance of incorporating patient preferences into economic evaluations.
Gabriel
S E
SE
Mayo Clinic and Foundation, Department of Health Sciences Research, Rochester, MN 55905.
Campion
M E
ME
O'Fallon
W M
WM
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000191:economics* / Q000627:therapeutic use; D009010:Monte Carlo Method; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D012680:Sensitivity and Specificity; D013276:Stomach Ulcer / Q000139:chemically induced / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016595:Misoprostol