The cost effectiveness of misoprostol prophylaxis alongside long-term nonsteroidal anti-inflammatory drugs. Implications of the MUCOSA trial

OBJECTIVE

This study considered the cost effectiveness of misoprostol prophylaxis for nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal damage, using data from the Misoprostol Ulcer Complications Outcomes Safety Assessment (MUCOSA) trial. The initial aim was to gain listing of misoprostol on the Australian National Formulary.

DESIGN

The economic evaluation followed a 2-stage approach in considering the cost effectiveness of misoprostol, a 'within-trial' analysis followed by a simple modelled analysis which explored the implications of the trial results for life-years saved beyond the trial setting. The perspective of the evaluation is that of the healthcare system.

SETTING

Three different populations were considered: the total trial population; patients with a history of peptic ulcer disease; and patients over 65 years of age.

STUDY POPULATION

Patient data were taken from the MUCOSA trial, which involved 8843 patients receiving continuous NSAID therapy for the control of rheumatoid arthritis.

INTERVENTIONS

Misoprostol plus any NSAID therapy was compared with placebo (no misoprostol) plus any NSAID therapy.

MAIN OUTCOME MEASURES AND RESULTS

The study found the incremental cost per definite serious gastrointestinal complication avoided with misoprostol was 39,603 Australian dollars ($A) for the total trial population, $A5599 for patients with a history of peptic ulcer disease and $A35,405 for patients over 65 years of age. The incremental cost per life-year saved with misoprostol was $A41,866 for the whole group, $A6244 for patients with a history of peptic ulcer disease and $A40,322 for patients over 65 years of age.

CONCLUSIONS

The study found misoprostol to be cost effective in this setting.

Cost-effectiveness of vitamin E therapy in the treatment of patients with angiographically proven coronary narrowing (CHAOS trial). Cambridge Heart Antioxidant Study

Epidemiologic studies have suggested that vitamin E (alpha-tocopherol) may play a preventive role in reducing the incidence of atherosclerosis. The aim of this paper was to conduct a cost-effectiveness analysis of vitamin E supplementation in patients with coronary artery disease using data from the Cambridge Heart Antioxidant Study (CHAOS). The study compared cost-effectiveness in the context of Australian and United States (US) health care utilization. The main clinical outcome used in the economic evaluation was the incidence of acute myocardial infarction (AMI) which was nonfatal. Utilization of health care resources was estimated by conducting a survey of Australian clinicians and published Australian and US cost data. Cost savings of $127 (A$181) and $578/patient randomized to vitamin E therapy compared with patients receiving placebo were found for Australian and US settings, respectively. Savings in the vitamin E group were due primarily to reduction in hospital admissions for AMI. This occurred because the vitamin E group had a 4.4% lower absolute risk of AMI than did the placebo group. Less than 10% of health care costs in the Australian evaluation was due to vitamin E ($150 [A$214/patient]). Our economic evaluation indicates that vitamin E therapy in patients with angiographically proven atherosclerosis is cost-effective in the Australian and US settings.

A profile of therapeutic opioid dependent persons in Queensland

This paper describes the philosophy and practice of the Drugs of Dependence Unit, Queensland Health, with regard to the collection and evaluation of dangerous drug prescription data. Using patient information extracted from the Monitoring of Dangerous Drugs Computer System and patient files at the unit, the paper presents a profile of 335 therapeutic opioid dependent persons who constituted the entire therapeutic caseload of the unit as at June 1992. The data include medical history, drug details, initial and final diagnosis, an escalation factor, and prognosis. Profile findings detail the prescribing patterns of medical practitioners and highlight the importance of continuous monitoring and review in the care and management of therapeutic opioid dependent persons.