PharmacoEconomics & Outcomes News 247 - 29 Jan 2000

costs in the IV omeprazole group were $HK1312Gastrointestinal news from thecompared with $HK3233 in the placebo group. TheISPOR 2nd Annual European corresponding costs per early rebleeding episode

Conference [ November 1999; prevented were $HK9946 and $HK12 821. Based onthese preliminary data, use of omeprazole in addition toEdinburgh, Scotland]endoscopic haemostasis appears to be a cost-effective

Gastrointestinal disease (GI) often starts as a relatively option.benign condition such as heartburn. However, a number

The downside of NSAIDsof GI conditions are either slowly progressive or of aThe potential for NSAIDs to induce GI complicationspersistent, chronic nature. In either case, effective

is widely recognised. The benefits of newer NSAIDs indiagnosis and treatment is important and cost data mayterms of gastrointestinal tolerability have been reportedhelp to identify the best approach.in clinical trials and, since the launch of some of these

Cost-of-illness analysis for dyspepsia agents in 1999, are now being assessed in a ‘real-life’Italian researchers outlined the establishment of an setting.

epidemiological database from general practitioner (GP) Total healthcare costs for a Medicare population indata to assist in the monitoring of dyspeptic patients in South Carolina, US, were significantly higher in patientsthe Ravenna area.1 Ten GPs agreed to follow a specified treated with an NSAID compared with those notpathway for diagnosis and therapy. However, all freely receiving NSAID therapy ($US2424 vs $US1747 perchose between empirical therapy (before gastroscopy) patient, respectively).5 Physician services, otheror specific therapy (after gastroscopy). ambulatory care and prescription drug costs were the

In patients who underwent gastroscopy, direct costs greatest contributors to this difference. In addition, costsaccounted for 76.5% of the total cost, and included were shown to be higher in women vs men and inantidyspeptic drug therapy (L153 000/patient)* , other African-Americans vs Caucasians, and in patients with adrugs (L305 000/ patient), tests (L206 000/patient) and previous GI adverse event vs in those without such aGP visits (L170 000/patient). Indirect productivity losses history.were associated with a per-patient cost of L264 000.

Save costs – use a pharmacistThus, the overall cost per patient was L1.122 million.French researchers used a decision-analysis model toThe total cost in patients who did not undergo

investigate the effects of pharmacist intervention beforegastroscopy was substantially lower, at L625 000/NSAID prescription.6 Overall, NSAID prescription errorspatient. Direct costs comprised 70.9% of the total, andoccurred in 446 cases. These included prescription ofthe cost of productivity losses was L182 000/patient.NSAIDs to a patient with GI risk factors, prescription of a

Eradicating Helicobacter pylori combination of NSAIDs and the NSAID dosage being tooFor patients treated in the Kaiser Permanente health high. Estimations from the model indicated that

maintenance organisation in the US, the H. pylori identification of an error in NSAID prescribing by aeradication rate after therapy with omeprazole + pharmacist could save the French Social Security FF1.04amoxicillin + clarithromycin was 85%.2 Patients had million–FF3.95 million* per year, and avoid 58–232been receiving long-term acid suppression therapy. peptic ulcers a year (30–120 of which would beCompliance with therapy was excellent, with 95 of 96 complicated). The study authors concluded thatpatients completing the 10-day course of therapy. In ‘pharmacist intervention is cost saving and has a clinicaladdition, adverse reactions occurred in only 6% of impact regard[ing] prescription errors’.patients.

Prevention is better than cureBased on the results of a previous trial showing noThe antiulcer agent misoprostol is often prescribed insignificant difference in efficacy for omeprazole +

combination with NSAIDs in an effort to reduce theamoxicillin + clarithromycin and ranitidine bismuthoccurrence of GI complications. In fact, a fixedcitrate + amoxicillin + clarithromycin, researchers fromcombination of misoprostol and diclofenac is availablethe Chinese University of Hong Kong presented cost-[‘Arthrotec’]. The MUCOSA study showed that thisminimisation data for these 2 regimens.3 Dr Joyce Youcombination reduced the NSAID-inducedreported that, from a hospital perspective, direct costsgastrointestinal toxicity by 40% in patients with arthritis.were significantly higher in omeprazole + amoxicillin +

Professor Peter Davey presented clinical practice dataclarithromycin recipients (outpatient cost of $HK4096*on 54 807 patients from a region in Scotland treatedvs $HK3839 for ranitidine bismuth citrate + amoxicillinwith either diclofenac/misoprostol or diclofenac alone.7+ clarithromycin, and inpatient cost of $HK13 042 vsRisk-adjusted rates of hospitalisation were reduced by$HK11 622, respectively). Dr You commented that the50% in combination therapy recipients. Significant riskresearchers were hoping to use their data to modifyfactors for GI events included the type and dose ofclinical practice at the associated teaching hospital.NSAID, concurrent exposure to antiulcer drugs,

Omeprazole cost effective in bleeding ulcer increasing patient age and a history of GI events. 30-dayEndoscopic haemostasis is the current therapeutic treatment and complication costs were £52* for

approach in patients with bleeding peptic ulcer. Interim diclofenac/misoprostol in a patient aged 80–89 yearsdata from a randomised clinical trial indicate that high- with a prior history of GI events compared with £86 fordose IV omeprazole significantly reduced the incidence diclofenac alone. This cost difference was not evident inof rebleeding over 72 hours, compared with placebo, low-risk patients (£16.50 for diclofenac/misoprostol in aafter endoscopic haemostasis in patients with bleeding 50- to 59-year-old patient with no history of GI events vspeptic ulcer. Dr Kenneth Lee from the Chinese £15 for diclofenac).University of Hong Kong, presented the results of an Professor Davey concluded that high-risk patientseconomic analysis of this trial.4 could be cost effectively treated with the diclofenac/

Within 72 hours of endoscopy, per-patient treatment misoprostol combination, but that the additional

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PharmacoEconomics & Outcomes News 29 Jan 2000 No. 2471173-5503/10/0247-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Single Article

prophylaxis would not make economic sense in low-riskpatients.

Managing constipation in managed careA US study assessed the costs associated with

constipation for patients from the PharMetricsIntegrated Outcomes database.8 A total of 9301 patientswere assessed. Medical expenditure was found toincrease dramatically in the 2 months prior to the firstvisit and diagnosis, and then decline sharply over thefollowing 2–3 months.

The average total cost 6 months prior to diagnosis was$US277; this increased to $US1031 during the month ofdiagnosis. Costs at 1 and 6 months after diagnosis were$US890 and $US479, respectively. The researchersconcluded that ‘early detection and resolution ofconstipation could result in significant cost savings formanaged care organizations’.

Irritable bowel syndrome costsunderestimated

Using ICD-9 codes to identify patients with irritablebowel syndrome (IBS), German researchers estimatedthat the total burden to German society was 53.5 millioneuros.9 However, they noted that conditions such as IBSare often undertreated, and as such are not wellrepresented in official statistics. Therefore ‘documentedresource use and the total cost of illness calculated usinginformation based on ICD9 coding might largelymisrepresent the burden of these diseases’.* L = Italian lire; $HK = Hong Kong dollars; FF = French francs; £ =pounds sterling

1. Triossi O, et al. Cost of Italian dyspeptic patients: a feasibility study from theDyspepsia Project. Value in Health 2: 398-399 (plus poster), Sep-Oct 1999.

2. Allison J, et al. Effectiveness of omeprazole, amoxicillin and clarithromycin ineradicating Helicobacter pylori in patients on chronic acid suppression for pepticulcer disease. Value in Health 2: 397 (plus poster), Sep-Oct 1999.

3. You JH, et al. Cost-minimization analysis of two triple regimens for thetreatment of Helicobacter pylori-related peptic ulcer disease. Value in Health 2:378-379 (plus poster), Sep-Oct 1999.

4. Lee KKC, et al. Cost-effectiveness analysis of high dose IV omeprazole infusionas adjuvant therapy to endoscopic haemostasis for bleeding peptic ulcers. Valuein Health 2: 366, Sep-Oct 1999.

5. Dickson WM, et al. Differential cost of using NSAIDs in a Medicaidpopulation. Value in Health 2: 398 (plus poster), Sep-Oct 1999.

6. Cousin C, et al. Evaluation of pharmacists’ interventions on prescribing errors ofnonsteroidal anti-inflammatory drugs: cost savings and clinical effects. Value inHealth 2: 366-367, Sep-Oct 1999.

7. Morant S, et al. Cost-effectiveness of the combination of misoprostol withdiclofenac in the Tayside population. Value in Health 2: 365-366, Sep-Oct 1999.

8. Bramley T, et al. Diagnosis and treatment of constipation in a managed carepopulation. Value in Health 2: 397-398 (plus poster), Sep-Oct 1999.

9. Volmer T, et al. Cost of illness studies may largely underestimate the cost ofdiseases with unmet medical need such as irritable bowel syndrome. Value inHealth 2: 399, Sep-Oct 1999.

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