Economic analysis of gastroprotective treatments in patients with chronic arthritis


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Elliott RA _ et al_. (2006) Preventing non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: are older strategies more cost-effective in the general population? _


Rheumatology_ 45: 606–613 Researchers from England have conducted an economic analysis to establish which gastroprotective treatments are cost-effective in patients with chronic arthritis


who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs). New drugs, such as the cyclo-oxygenase 2 (COX2)-selective inhibitors (coxibs) generally cost more than existing drugs;


however, claims of improved safety and efficacy for new drugs can prematurely reduce the use of existing drugs. Data from a previously published systematic review, which included 74,666


patients with chronic arthritis from 112 randomized, controlled trials of gastroprotective treatments, were combined with up-to-date UK resource-use and unit-cost data. The authors ranked


the available treatments from least safe to most safe, with respect to gastrointestinal toxicity: NSAIDs alone; COX2-preferential inhibitors; NSAIDs plus H2-receptor antagonists (H2RAs);


coxibs; NSAIDs plus misoprostol; and NSAIDs plus proton-pump inhibitors (PPIs). They also ranked these treatments from least expensive to most expensive per quality-adjusted life-year


(QALY): NSAIDs plus H2RAs; NSAIDs plus misoprostol; NSAIDs alone; coxibs; COX2 preferential inhibitors; and NSAIDs plus PPIs. Analysis showed that NSAIDs plus H2RAs are safer and less costly


than NSAIDs alone. If health-care expenditure of £140,000 per QALY is acceptable, NSAIDs plus H2RAs are the optimal treatment, but if expenditure of >£140,000 per QALY is possible, then


NSAIDs plus PPIs are the optimal treatment. The analysis was limited by the quality of available data and by assumptions made in the analytic model. Further studies should be carried out to


improve the quality of information available to decision makers. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Economic analysis of gastroprotective


treatments in patients with chronic arthritis. _Nat Rev Rheumatol_ 2, 406 (2006). https://doi.org/10.1038/ncprheum0241 Download citation * Issue Date: August 2006 * DOI:


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