low cost does not mean cost effective

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8 INTERNATIONAL RESEARCH & OPINION 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 I g/day, ibuprofen 2.4 g/day or ibuprofen 2.4 g/day plus misoprostol 800 /lg/day. 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 combination 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 cost-effectiveness of NSAlDs Although drug costs alone made nabumetone the more expensive option ($US 1211patient for nabumetone vs $45/patient for ibuprofen; 1992 $US), the lower incidence of endoscopic lesions with nabumetone greatly reduced the cost of NSAID-related adverse events [see table). 3-month direct costs of treating osteoarthriti and NSAID-related adverse events (1992 SUS/patient) Nabumetone Ibuprofen Ibuprofen + mlsoprostol Treatment of osteoarthritis Drug 121 45 199 Nondrug' 42 42 42 Subtotal 163 87 241 Treatment of adverse drug reactions Drug 2 12 6 Nondrug' 18 153 23 Subtotal 20 165 29 Total cost of treatment 183 252 270 • Nondrug costs Include physician visits, tests, procedures and hospitalisation Combining misoprostol with ibuprofen can protect against NSAID-related lesions and, hence, reduce adverse event-related costs by $ I 36/patient. However, this combination does increase drug costs, the investigators point out. Thus, the total cost for nabumetone-treated patients was $1 83/patient, compared with $252/patient and $270/patient for those treated with ibuprofen- and ibuprofen plus misoprostol, respectively. 21 May 1994 PHARMACORESOURCES 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 10. Baker AM, Kaplan H. Nabumetone in elderly patients with osteoanhritis: ec'onomic benefits ve rsus ibuprofen alone or ibuprofen plus misoprostol. PharmacoEconomics 5: 335 -342, Apr 1994 "",.,,'" 1172-8299/94/0005-0008/$01.00(; Adis International Limited 1994, All rights reserved

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Page 1: Low cost does not mean cost effective

8 INTERNATIONAL RESEARCH & OPINION

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 I g/day, ibuprofen 2.4 g/day or ibuprofen 2.4 g/day plus misoprostol 800 /lg/day. 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 combination 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 cost-effectiveness of NSAlDs Although drug costs alone made nabumetone the

more expensive option ($US 1211patient for nabumetone vs $45/patient for ibuprofen; 1992 $US), the lower incidence of endoscopic lesions with nabumetone greatly reduced the cost of NSAID-related adverse events [see table).

3-month direct costs of treating osteoarthriti and NSAID-related adverse events (1992 SUS/patient)

Nabumetone Ibuprofen Ibuprofen + mlsoprostol

Treatment of osteoarthritis

Drug 121 45 199

Nondrug' 42 42 42

Subtotal 163 87 241

Treatment of adverse drug reactions

Drug 2 12 6

Nondrug' 18 153 23

Subtotal 20 165 29

Total cost of treatment

183 252 270

• Nondrug costs Include physician visits, tests, procedures and hospitalisation

Combining misoprostol with ibuprofen can protect against NSAID-related lesions and, hence, reduce adverse event-related costs by $ I 36/patient. However, this combination does increase drug costs, the investigators point out. Thus, the total cost for nabumetone-treated patients was $1 83/patient, compared with $252/patient and $270/patient for those treated with ibuprofen- and ibuprofen plus misoprostol, respectively.

21 May 1994 PHARMACORESOURCES

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 10. Baker AM, Kaplan H. Nabumetone in elderly patients with osteoanhritis: ec'onomic benefits versus ibuprofen alone or ibuprofen plus misoprostol. PharmacoEconomics 5: 335-342, Apr 1994 "",.,,'"

1172-8299/94/0005-0008/$01.00(; Adis International Limited 1994, All rights reserved