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 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.