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Economic analysis of strategies in the prevention of non‐steroidal anti‐inflammatory drug‐induced complications in the gastrointestinal tract
Author(s) -
Lanas A.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2004.02078.x
Subject(s) - medicine , drug , omeprazole , medical prescription , intensive care medicine , gastrointestinal bleeding , gastrointestinal tract , incidence (geometry) , pharmacotherapy , cost effectiveness , pharmacology , risk analysis (engineering) , physics , optics
SummaryBackground : 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. Aim : 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.