title: Nabumetone in elderly patients with osteoarthritis: economic benefits versus ibuprofen alone or ibuprofen plus misoprostol.
abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) vary in their potential to produce gastropathy.  We compared the 3-month direct medical costs, including those associated with treating NSAID-induced adverse events, of nabumetone, ibuprofen, or ibuprofen plus misoprostol in 171 elderly patients with osteoarthritis.  Total direct medical costs per patient treated were $US183 for nabumetone, $US252 for ibuprofen, and $US270 for ibuprofen plus misoprostol. Differences resulted from higher costs associated with treatment of drug-related adverse events with ibuprofen, and higher drug acquisition prices with the combination regimen.  Sensitivity analyses demonstrated that direct costs with nabumetone approached those for the other 2 regimens if the price of nabumetone increased by 60%, the probability of lesion formation with nabumetone increased 4-fold, the probability of a lesion greater than 0.5cm being symptomatic and needing treatment was 31%, or the price of misoprostol decreased by 50%.  Although this study found more lesions because of mandated endoscopies than might be recognised or treated in clinical practice, the results suggest an economic benefit of nabumetone.
authors.affiliation: Arthur D. Little, Inc., Cambridge, Massachusetts.
authors.forename: J D
authors.initials: JD
authors.lastname: Bentkover
authors.forename: A M
authors.initials: AM
authors.lastname: Baker
authors.forename: H
authors.initials: H
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D002074:Butanones / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007052:Ibuprofen / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D016595:Misoprostol / Q000191:economics / Q000627:therapeutic use; D010003:Osteoarthritis / Q000188:drug therapy*