Cost effectiveness and cost utility of acetylcysteine versus dimethyl sulfoxide for reflex sympathetic dystrophy.
OBJECTIVE
To determine the cost effectiveness and cost utility of acetylcysteine versus dimethyl sulfoxide (DMSO) for patients with reflex sympathetic dystrophy (RSD), from a societal viewpoint.


METHODS
An economic evaluation was conducted alongside a double-dummy, double-blind, randomised, controlled trial. Patients were followed for 1 year. The primary outcome measure was the Impairment-level Sum Score (ISS). Utilities were determined by the EuroQOL instrument (EQ-5D). Both cost-effectiveness and cost-utility analyses were performed. Differences in mean direct, indirect and total costs were estimated. Corresponding 95% confidence intervals were calculated by bootstrapping techniques.


RESULTS
Both groups (DMSO, n = 64; acetylcysteine, n = 67) showed relevant improvement; no differences in effects were found. Only the total direct costs were significantly lower in the DMSO group for the period of 0-52 weeks. The incremental cost-effectiveness ratios showed that, in general, DMSO generated fewer costs and more effects compared with acetylcysteine. Post-hoc subgroup analyses on cost effectiveness suggested that patients with warm RSD could be best treated with DMSO and patients with cold RSD with acetylcysteine. These results were based on small subsamples.


CONCLUSIONS
In general, DMSO is the preferred treatment for patients with RSD.
van Dieten
Hiske E M
HE
Department of Clinical Epidemiology and Biostatistics, Vrije Universiteit, Amsterdam, Netherlands.
Perez
Roberto S G M
RS
van Tulder
Maurits W
MW
de Lange
Jaap J
JJ
Zuurmond
Wouter W A
WW
Ader
Herman J
HJ
Vondeling
Hindrik
H
Boers
Maarten
M
D000111:Acetylcysteine / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003625:Data Collection; D004121:Dimethyl Sulfoxide / Q000191:economics* / Q000627:therapeutic use; D004311:Double-Blind Method; D016527:Drug Costs; D005260:Female; D016166:Free Radical Scavengers / Q000191:economics* / Q000627:therapeutic use; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D008297:Male; D009426:Netherlands; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome
D016166:Free Radical Scavengers; D000111:Acetylcysteine; D004121:Dimethyl Sulfoxide