[Cost-effectiveness of preventive treatment with misoprostol in non-steroidal anti-inflammatory agents related gastric ulcers]

The prophylactic use of misoprostol for patients with osteoarthritis and abdominal pain receiving non steroid anti-inflammatory drugs has been shown to reduce the incidence of gastric ulcers by a factor of 15. We studied the direct medical expenses related to this treatment, as compared to no prevention. Considering only ulcers over 3 mm, a daily dose of 400 micrograms/day, with a compliance rate of 60 percent and a 40 percent rate of silent ulcers, prevention induced an extra cost of 131 FF per payor for 3 months. For the French illness fund, the extra cost was 54 FF while patient copayment was 77 FF. Prevention was calculated to prevent 84 gastric ulcers per 1,000 cases. Results are very dependent on the variability of clinical results, the price of the drug, but less on the cost of the ambulatory treatment of ulcer and on the rate of hospitalization. It was not possible to extrapolate results beyond 3 months. This model did not take into account indirect costs such as loss of work hours, as well as qualitative benefits of prevention such as better compliance to NSAIDs. These factors would improve the cost-effectiveness of treatment. Prevention by misoprostol should be compared with other antiulcer drugs which have not yet proven their preventive efficacy.