Gabriel S E, Jaakkimainen R L, Bombardier C
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905.
Arthritis Rheum. 1993 Apr;36(4):447-59. doi: 10.1002/art.1780360404.
To compare, in a Canadian health care setting, the costs and consequences of 3 strategies of misoprostol prophylaxis for osteoarthritis patients: prophylaxis for all patients taking nonsteroidal antiinflammatory drugs (NSAIDs), for no patients taking NSAIDs, and for only elderly patients (age > or = 60) taking NSAIDs.
We designed a decision-analysis model which incorporated costs (estimated with ulcer patient profiles and medical records), review, and probabilities (estimated from a companion meta-analysis, selected literature review, and Ontario Ministry of Health Statistics). Effectiveness was defined as the number of episodes of gastric ulceration requiring hospitalization or outpatient management that were averted by each strategy.
On average, prophylaxis cost an additional $650 for every additional gastrointestinal event prevented. Prophylaxis for elderly NSAID users was cost saving if the ulcer complication rate in this group exceeds 1.2%, or if either the charges for outpatient ulcer treatment exceed $2,000, or the 3-month price of misoprostol is < or = $90.
Our results demonstrate that, in this setting, misoprostol prophylaxis may be highly cost effective.
在加拿大医疗环境中，比较米索前列醇预防骨关节炎患者的三种策略的成本和后果：对所有服用非甾体抗炎药（NSAIDs）的患者进行预防、对不服用NSAIDs的患者不进行预防以及仅对服用NSAIDs的老年患者（年龄≥60岁）进行预防。
我们设计了一个决策分析模型，该模型纳入了成本（根据溃疡患者资料和医疗记录估算）、回顾以及概率（根据一项配套的荟萃分析、选定的文献回顾和安大略省卫生部统计数据估算）。有效性定义为每种策略避免的需要住院或门诊治疗的胃溃疡发作次数。
平均而言，每预防一例额外的胃肠道事件，预防措施需额外花费650美元。如果该组溃疡并发症发生率超过1.2%，或者门诊溃疡治疗费用超过2000美元，或者米索前列醇3个月的价格≤90美元，那么对老年NSAIDs使用者进行预防可节省成本。
我们的结果表明，在这种情况下，米索前列醇预防可能具有很高的成本效益。
