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Gastroprotective strategies in chronic NSAID users: a cost-effectiveness analysis comparing single-tablet formulations with individual components.
Value Health. 2013 Jul-Aug; 16(5):769-77.VH

Abstract

OBJECTIVES

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.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. n.l.degroot-3@umcutrecht.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23947970

Citation

de Groot, N L., et al. "Gastroprotective Strategies in Chronic NSAID Users: a Cost-effectiveness Analysis Comparing Single-tablet Formulations With Individual Components." Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research, vol. 16, no. 5, 2013, pp. 769-77.
de Groot NL, Spiegel BM, van Haalen HG, et al. Gastroprotective strategies in chronic NSAID users: a cost-effectiveness analysis comparing single-tablet formulations with individual components. Value Health. 2013;16(5):769-77.
de Groot, N. L., Spiegel, B. M., van Haalen, H. G., de Wit, N. J., Siersema, P. D., & van Oijen, M. G. (2013). Gastroprotective strategies in chronic NSAID users: a cost-effectiveness analysis comparing single-tablet formulations with individual components. Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research, 16(5), 769-77. https://doi.org/10.1016/j.jval.2013.05.002
de Groot NL, et al. Gastroprotective Strategies in Chronic NSAID Users: a Cost-effectiveness Analysis Comparing Single-tablet Formulations With Individual Components. Value Health. 2013 Jul-Aug;16(5):769-77. PubMed PMID: 23947970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gastroprotective strategies in chronic NSAID users: a cost-effectiveness analysis comparing single-tablet formulations with individual components. AU - de Groot,N L, AU - Spiegel,B M R, AU - van Haalen,H G M, AU - de Wit,N J, AU - Siersema,P D, AU - van Oijen,M G H, Y1 - 2013/07/11/ PY - 2012/07/11/received PY - 2013/02/27/revised PY - 2013/05/01/accepted PY - 2013/8/17/entrez PY - 2013/8/21/pubmed PY - 2013/11/13/medline KW - compliance KW - cost-effectiveness KW - cost-utility KW - dyspepsia KW - gastrointestinal bleeding KW - nonsteroidal anti-inflammatory drugs KW - proton pump inhibitors SP - 769 EP - 77 JF - Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research JO - Value Health VL - 16 IS - 5 N2 - OBJECTIVES: 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. SN - 1524-4733 UR - https://www.unboundmedicine.com/medline/citation/23947970/Gastroprotective_strategies_in_chronic_NSAID_users:_a_cost_effectiveness_analysis_comparing_single_tablet_formulations_with_individual_components_ DB - PRIME DP - Unbound Medicine ER -