Cost Benefit Higher relapse rates render cimetidine less cost-effective than misoprostol

There are two approaches to ulcer therapy: neutralisation or secretion suppression of gastric acid, or more recently, the use of agents that enhance the mucosal defense mechanisms. Normal ulcer therapy consists of a 4-8 week course of acute treatment, followed by daily maintenance therapy if the ulcer recurs. With such long term therapy, cost effectiveness is an important consideration in drug prescription.

Studies have shown that both misoprostol and cimetidine are effective in the healing of acute peptic ulcer, but that patients treated with cimetidine are more likely to suffer relapse. Relapsing patients also demonstrate a shorter period between flare-ups if treated with cimetidine rather than misoprostol. The implications of the differences in relapse rates in terms of cost, plus the cost of work loss, side effects and overall medical treatment have been compared for the 2 drugs.

Treatment costs were calculated on the basis of a standard protocol including physician visits, endoscopy, drug cost and return visit to physician leading to continued or discontinued treatment. At the time of study misoprostol was 69% the cost of cimetidine.

Side effects can result in additional costs in terms of additional physician visits and drug prescriptions. The incidence of side effects associated with cimetidine was estimated to be 1.5 and 2.1 % for short and long term treatment, respectively, and 0.4% with misoprostol treatment.

The average number of work days lost per episode of peptic ulcer was calculated to be 1.29. All patients were estimated to lose an average of 3.44 and 1.93 days in the first and subsequent years, respectively, when taking misoprostol, and 3.54 and 2.10 days when taking cimetidine.

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All the above factors were taken into consideration in a final 5-year cost summary. Misoprostol was found to be the cheaper treatment, especially in patients with no previous ulcer history. In patients without a previous history of ulcers, treatment with misoprostol was estimated to cost 57% that of cimetidine. In all patients, misoprostol treatment cost some 70% of cimetidine treatment.

The authors concluded that 'In this particular Instance, treatment with the less-expenslve drug Is clearly the most rational'. Lanza F. Peace KE. Zimmerman H. Dickson B. Cost·effectiveness of cimetidine and misoprostol in peptic ulcer disease. Drug Information Journal 22: 449·457. No.3. 1988 .,,'

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