Economic analysis of strategies in the prevention of non-steroidal anti-inflammatory drug-induced complications in the gastrointestinal tract.
BACKGROUND
It is unclear what the best therapeutic approach is in patients who require non-steroidal anti-inflammatory drugs. In clinical practice, choice of prescriptions are often based on drug costs.


OBJECTIVE
To evaluate costs per upper gastrointestinal bleeding avoided with different prevention strategies.


METHODS
Two major strategies have been considered (coxibs vs. non-steroidal anti-inflammatory drugs plus generic/brand gastroprotective agent). The number of patients needed to treat to prevent a bleeding event, the cost of the drug and duration of treatment were used to estimate costs.


RESULTS
Based on hospitalization costs of a bleeding event, no therapeutic strategy is cost-effective in patients without risk factors. All strategies (including omeprazole + coxib) are cost-effective in patients with bleeding ulcer history. With other risk factors, all strategies are cost-effective but prevention of events is twice as expensive in patients <75 years of age. No strategy shows superiority unless the cheapest generics are prescribed or a 50% reduction in the incidence of lower gastrointestinal complications with coxibs is confirmed.


CONCLUSIONS
Current prevention strategies to reduce serious non-steroidal anti-inflammatory drug-associated gastrointestinal events are only cost-effective in patients with risk factors. No strategy shows superiority, but coxib strategy would be more cost-effective if it were associated with a reduction of events of the lower gastrointestinal tract.
Service of Gastroenterology, Clinic University Hospital, Zaragoza, Spain. alanas@unizar.es
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Lanas
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000191:economics / Q000517:prevention & control*; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal