low cost does not mean cost effective
TRANSCRIPT
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