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A Review of Conflicting Economic Evaluations

Gerold Stucki, MD; Magnus Johannesson, PhD; Matthew H. Liang, MD, MPH

Arch Intern Med. 1994;154(18):2020-2025.

Abstract
Whether misoprostol, a synthetic prostaglandin E¹ analogue, should be routinely prescribed along with nonsteriodal anti-inflammatory drugs (NSAIDS) to prevent gastric damage is of great clinical importance and has profound cost implications. No consensus exists on whether misoprostol cotherapy results in a cost-saving, is cost-effective, or is costly. The different conclusions reached by five economic evaluations of misoprostol can be explained solely by the assumed absolute risk reduction of symptomatic ulcer, which was more than seven times greater in the studies that concluded that misoprostol was cost-effective than in a study that concluded misoprostol to be costly. Since no study has directly shown the effectiveness of misoprostol cotherapy in preventing clinically significant ulcer disease (ie, hemorrhage and preforation), it is impossible to judge which assumptions are most appropriate. The absence of firm data on the rate of NSAID-induced gastric ulcers reduced by misoprostol makes it impossible to conclude whether it is cost-effective in patients with chronic arthritis who use NSAIDS.

(Arch Intern Med. 1994;154:2020-2025)

Author Affiliations
From the Department of Health Policy and Management, Harvard School of Public Health (Drs Stucki, Johannesson, and Liang), and the Departments of Medicine (Dr Liang) and Rheumatology/Immunology (Dr Liang) and Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Disease Center (Drs Stucki and Liang), Brigham and Women's Hospital, Boston, Mass. Dr Johannesson is now with the Centre for Health Economics, Stockholm (Sweden) School of Economics.

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