Oral prednisolone is more cost-effective than oral indomethacin for treating patients with acute gout-like arthritis.
OBJECTIVE
Acute gouty arthritis is often treated with NSAIDs, but recent studies have suggested that treatment with prednisolone has at least equivalent analgesic efficacy and fewer adverse effects. No formal economic analysis has been performed earlier. In this study, we aimed to compare the economic impact of oral indomethacin therapy and oral prednisolone therapy in the treatment of acute gout in patients presenting to an emergency department in Hong Kong.


METHODS
Data from a previously published randomized controlled trial were used to compare the costs of the two treatment options. Direct, incremental costs incurred in the 2 weeks after the initial presentation were considered from the perspective of the healthcare provider. Costs were subdivided into those incurred in the emergency department phase; admission on day 1 to the emergency department's observation ward; admission subsequently to the general medical ward for adverse events and reattendance to the hospital outpatients' or emergency department.


RESULTS
The prednisolone strategy resulted in cost savings in the emergency department of HK$5.67 (US$0.73; pound0.37) and in medical admissions of HK$1727.48 (US$221.47; pound111.45) per patient treated. Overall, the average saving with prednisolone was HK$1235 (US$158.33; pound79.68) per patient treated, which was equivalent to one admission bed/day saved for every two patients treated. Treatment for each of the six patients in the indomethacin group admitted for serious adverse effects cost the healthcare provider HK$13 244 (US$1697.95; pound854.45).


CONCLUSIONS
Treatment of acute gouty arthritis with a 5-day course of prednisolone is significantly more cost-effective than treatment with indomethacin.
Cattermole
Giles N
GN
Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong , Hong Kong.
Man
Chi Yin
CY
Cheng
Chi Hung
CH
Graham
Colin A
CA
Rainer
Timothy H
TH
D000284:Administration, Oral; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D015210:Arthritis, Gouty / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000191:economics*; D011239:Prednisolone / Q000008:administration & dosage / Q000191:economics*; D016032:Randomized Controlled Trials as Topic
D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D007213:Indomethacin