Management of Nonsteroidal Anti-inflammatory Drug-Associated Lesions: A Cost-Effectiveness Perspective

Results are presented from a cost-effectiveness analysis of the acute healing phases of two new clinical studies. Acute treatment with omeprazole, 20 mg once daily, is compared with misoprostol, 200 μg four times daily, or ranitidine, 150 mg twice daily, in patients with nonsteroidal anti-inflammatory drug (NSAID)-associated gastroduodenal lesions (gastric ulcer, duodenal ulcer, and/or >10 erosions in either the stomach or duodenum). The cost-effectiveness comparisons indicate that omeprazole is cost-effective when compared with ranitidine in the treatment of gastric ulcers, duodenal ulcers, and erosions only, and that omeprazole is cost-effective when compared with misoprostol in the treatment of gastric ulcers and duodenal ulcers. In patients with erosions only, misoprostol is cost-effective when compared with omeprazole. When assessing the uncertainty of these estimates, a definite conclusion can be made in only two comparisons: omeprazole is cost-effective when compared with ranitidine in the treatment of gastric ulcers, and misoprostol is cost-effective when compared with omeprazole in the treatment of erosions only. However, the clinical studies were not powered for assessing the cost-effectiveness of the treatment alternatives, which impedes the uncertainty assessment. The determinants of the cost-effectiveness of prophylactic strategies are also discussed, as well as the need for further studies that include relevant outcome measures and a design that reflects actual clinical practice.