low cost does not mean cost-effective
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6 PHARMACOECONOMICS Low cost does not mean cost-effective
'The most cost-effective treatment does not necessarily require the use of the least costly drug'. This is the conclusion of US investigators following their decision analysis which compared the costs associated with 3 NSAID regimens in elderly patients with osteoarthritis.
The decision analysis model was based on the frequency of various adverse events obtained from a clinical trial comparing the safety and efficacy of nabumetone 191day, ibuprofen 2.4 glday or ibuprofen 2.4 glday plus misoprostol800 Ilglday. The study involved 171 elderly patients with osteoarthritis over a 3-month period. According to physician evaluation, improvement was observed in 64% of nabumetone recipients, 55% of ibuprofen recipients and 63% of ibuprofen plus misoprostol recipients. Notably, patients receiving ibuprofen developed significantly more GI lesions than patients receiving nabumetone or combina-tion therapy. Furthermore, symptomatic adverse events requiring medical attention were reported: 5 cases in the nabumetone group; 10 cases in the ibuprofen group; and 20 cases in the ibuprofen plus misoprostol group.
Examining cmt-eft'ectiv~ ofNSAIDs Although drug costs alone made nabumetone the
more expensive option (SUS 1211patient for nabumetone vs $45/patient for ibuprofen; 1992 SUS), the lower incidence of endoscopic lesions with nabumetone greatly reduced the cost of NSAID-related adverse events [see table]. Combining misoprostol with ibuprofen can protect against NSAID-related lesions and, hence, reduce adverse event-related costs by Sl36/patient. However, this combination does increase drug costs, the investigators point out. Thus, the total cost for nabumetone-treated patients was S183/patient, compared with $2521patient and S270/patient for those treated with ibuprofen and ibuprofen plus misoprostol, respectively.
Tt"IIIII/MIrt of ~
Drug 121 45 199 Nondrug" 42 42 42
swrot.I 163 87 241
Tr.tment of edvwM drug reectloM
Drug 2 12 6 Nondrug' 18 153 23
Subtotal 20 165 29
TotIII coet of trMtment
183 252 270
Nondrug costa Include physician , tests, procedures Itld ho8pIIaIiI8 on
Importantly, the inclusion of indirect costs - such as those attributed to lost work time or productivity, or to a patient's reduced capability to participate in leisure activities - would emphasise the differences between the 3 treatments even more, conclude the investigators. Bentkover m. Baker AM. Kaplan H. Nabumetone in elderly patients with osteoarthritis: economic benefits versus ibuprofen alone or ibuprofen plus misoprostol. PharmacoEconomics 5: 335-342. Apr 1994 OIl""l
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