Hospital Pharmacy - October 2020 - 295

295

2006 * Systematic

reviews of outcomes and UK cost
data were combined in an incremental economic
analysis.
* Incremental cost-effectiveness ratios were
generated for QALYs gained.
* The meta-analysis included patients with chronic
arthritis (primarily rheumatoid arthritis and
osteoarthritis) who require
* regular NSAIDs for more than 3 weeks.

Year Methodology

Outcome

Conclusion

* To
combine data from
different sources, the authors
assumed that the source
populations are comparable
(which is a limitation of all
models).
* Direct health care costs were
available only as reported
estimation from clinicians.
* There is very little
information on the relative
effectiveness of the 5
strategies due to the lack of
head-to-head studies.
* Probability estimates used
in the model are from
heterogeneous studies.
* Different patient groups,
follow-up periods, and quality
of data make it difficult to
precisely estimate the mean
probability.

Limitation

Note. PPI = proton pump inhibitor; H2RA = histamine-2 receptor antagonist; QALYs = quality-adjusted life years; NSAID = nonsteroidal anti-inflammatory drug; tNSAID = traditional nonsteroidal
anti-inflammatory drug; WTP = willingness to pay.

* The tNSAID
* Mean

expected cost for tNSAID and
and PPI is
PPI is £200 for 0.4988 QALY gained,
safer strategy
whereas mean expected costs for
compared with
tNSAID and H2RA is £120 per 0.4982
QALY gained.
tNSAID and
* The incremental increase in QALYs
H2RA.
* The tNSAID
gained by using tNSAID and PPI costs
and PPI is
more than cost per QALYs gained by
more costly
using tNSAID and H2RA.
* If the decision-makers pay up to 140
strategy
000 pounds per extra QALY, the
compared with
optimal strategy is tNSAID/H2RA.
tNSAID and
* If the decision-makers pay over 140
H2RA.
000, the optimal strategy is tNSAID/PPI.
2013 * A cost-utility analysis to compare 8 gastroprotective * For average-risk patients, NSAID + PPI * NSAID + PPI
de Groot
strategies managing a hypothetical cohort of
co-therapy
et al15 (the
co-therapy was the most cost-effective.
Netherlands)
60-year old patients with rheumatoid arthritis or
is the most
* By using Monte Carlo analysis, the
osteoarthritis and requiring chronic NSAID therapy:
cost-effective
strategies were compared across
- NSAID mono-therapy
strategy in
cohorts of 10 000 patients, considering
- NSAID + PPI
all patients
different probabilities and risks.
- NSAID/PPI single-tablet
with chronic
* For a WTP threshold of €20 000 per
- NSAID + H2RA
arthritis
QALY gained, the probability of being
- NSAID/H2RA
irrespective of
cost-effective was the highest for
- NSAID + misoprostol
their risk for
NSAID and PPI co-therapy users with
- NSAID/misoprostol single-tablet formulation
gastrointestinal
57%, followed by NSAID and H2RA
with 17%.
- Coxib monotherapy
complication.
* Markov model developed by using decision-analysis * If the WTP threshold was below €13
000, the probability of being costsoftware (Tree Age Pro 2009, Tree Age Software,
effective was also the highest for
Inc, Williams town, Massachusetts).
NSAID and PPI co-therapy.
* Through a series of 3-month Markov transition
cycles, the cohort over a 5-year time horizon was
followed.
* QALYs were used as effectiveness outcome.
* Overall outcome was the incremental costeffectiveness ratio evaluating differences in both
costs and QALYs.
* A cost-effectiveness threshold of €20 000 per
QALY gained was determined following Dutch
national guidelines. We discounted all utilities at an
annual rate of 3%, as recommended by the US Panel
on Cost-Effectiveness in Health and Medicine

Elliott et al
(UK)

Author

Table 2. Cost-effectiveness of Treatment by PPI Compared With H2RA.

Hospital Pharmacy - October 2020

Table of Contents for the Digital Edition of Hospital Pharmacy - October 2020