A decision analysis model in the evaluation of NSAIDs in a managed care setting: a case study.
The objective of this study is to utilize a clinical trial based on a decision-analysis model to assess the economic benefit of a lower incidence of gastrointestinal lesions in elderly patients with osteoarthritis receiving nabumetone therapy compared with ibuprofen alone and in combination with misoprostol. An arthritic population of an HMO (> 60 yr of age) was applied to the decision analysis based on the HMO's nonsteroidal anti-inflammatory drug and antiulcer usage and acquisition costs. Results indicate the potential for a decrease in overall medical resource utilization through the use of nabumetone in elderly patients with rheumatoid and osteoarthritis. Based on this information, nabumetone has been added to the HMO formulary as a second-tier agent with a repeat of the analysis scheduled in one year to verify the economic benefits and modify prescribing guidelines accordingly.
Brixner
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SmithKline Beecham Pharmaceuticals, Philadelphia, PA 19101.
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics; D002074:Butanones / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D003663:Decision Trees; D004359:Drug Therapy, Combination; D005569:Formularies as Topic; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015994:Incidence; D008875:Middle Aged; D016595:Misoprostol / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D018803:Models, Economic; D015205:Northwestern United States; D010003:Osteoarthritis / Q000188:drug therapy / Q000191:economics