Gastroprotective strategies in chronic NSAID users: a cost-effectiveness analysis comparing single-tablet formulations with individual components.
OBJECTIVE
To evaluate the cost-effectiveness of competing gastroprotective strategies, including single-tablet formulations, in the prevention of gastrointestinal (GI) complications in patients with chronic arthritis taking nonsteroidal anti-inflammatory drugs (NSAIDs).


METHODS
We performed a cost-utility analysis to compare eight gastroprotective strategies including NSAIDs, cyclooxygenase-2 inhibitors, proton pump inhibitors (PPIs), histamine-2 receptor antagonists, misoprostol, and single-tablet formulations. We derived estimates for outcomes and costs from medical literature. The primary outcome was incremental cost per quality-adjusted life-year gained. We performed sensitivity analyses to assess the effect of GI complications, compliance rates, and drug costs.


RESULTS
For average-risk patients, NSAID + PPI cotherapy was most cost-effective. The NSAID/PPI single-tablet formulation became cost-effective only when its price decreased from €0.78 to €0.56 per tablet, or when PPI compliance fell below 51% in the NSAID + PPI strategy. All other strategies were more costly and less effective. The model was highly sensitive to the GI complication risk, costs of PPI and NSAID/PPI single-tablet formulation, and compliance to PPI. In patients with a threefold higher risk of GI complications, both NSAID + PPI cotherapy and single-tablet formulation were cost-effective.


CONCLUSIONS
NSAID + PPI cotherapy is the most cost-effective strategy in all patients with chronic arthritis irrespective of their risk for GI complications. For patients with increased GI risk, the NSAID/PPI single-tablet formulation is also cost-effective.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. n.l.degroot-3@umcutrecht.nl
N L
NL
de Groot
B M R
BM
Spiegel
H G M
HG
van Haalen
N J
NJ
de Wit
P D
PD
Siersema
M G H
MG
van Oijen
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000191:economics*; D001168:Arthritis / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D003661:Decision Support Techniques; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000517:prevention & control*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D008390:Markov Chains; D016595:Misoprostol / Q000008:administration & dosage / Q000191:economics; D018803:Models, Economic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000191:economics; D019057:Quality-Adjusted Life Years; D016903:Drug Monitoring
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D004338:Drug Combinations; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D016595:Misoprostol
compliance; cost-effectiveness; cost-utility; dyspepsia; gastrointestinal bleeding; nonsteroidal anti-inflammatory drugs; proton pump inhibitors