Cost-effectiveness of misoprostol for prophylaxis against nonsteroidal anti-inflammatory drug-induced gastrointestinal tract bleeding

Article Abstract:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for a large number of patients with conditions such as arthritis; these drugs are used by over 8 percent of the United States population. A serious and potentially fatal side effect of the NSAIDs is bleeding in the upper gastrointestinal tract, particularly the stomach. In the majority (60 percent) of these bleeding complications, the patient experiences no warning signs before the life-threatening bleeding occurs. The drug misoprostol (Cytotec) is effective in preventing NSAID-induced bleeding in the stomach, but not in the duodenum (the upper part of the small intestine). Since most ulcers due to NSAIDS occur in the stomach, preventative (prophylactic) use of misoprostol has been recommended for patients who must use NSAIDs. However, it has been suggested that the cost of this approach may exceed the benefits. This study evaluated the cost-benefit ratio for prophylactic use of misoprostol in NSAID users. The data were obtained from a review of the research literature. Cost-effectiveness was expressed in various ways, including direct medical costs and cost per year of life saved (YOLS). NSAID users were divided into several groups for the analysis. The cost-effectiveness ratio for misoprostol per YOLS was high: for all NSAID users, $667,400 per YOLS; and for users over age 60, $186,700 per YOLS. These costs are higher than the costs of accepted public health prevention measures, such as drug therapy for high blood pressure. However, the cost-effectiveness was much better for a specific group of NSAID users, those with a documented history of gastrointestinal bleeding; for this group the cost was under $40,000 per YOLS. In conclusion, misoprostol is costly as a preventive measure for most NSAID users, including those with no history of gastrointestinal bleeding, but may be cost-effective in the sub-group with such a history. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Economic aspects, Product/Service Evaluation, Prevention, Ulcers, Arthritis, Misoprostol, Stomach ulcer, Cytotec (Medication)

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Synovial fluid tests: what should be ordered?

Article Abstract:

When a patient has a painful, swollen joint, one way a clinician can differentiate between an infection and an inflammatory process, such as osteoarthritis, is by examining the fluid of the joint (synovial fluid). The synovial fluid can be screened for bacteria or other organisms; examined by microscope for the number and types of white blood cells; and submitted for chemical analysis. The present study examined the value of these various tests and compared the findings with the final diagnosis, which was made independent from synovial fluid testing. Testing the synovial fluid white blood cell population was found to be useful in differentiating between inflammatory and noninflammatory diseases. In a subgroup of 19 patients with infections of the synovial space, microscopic examination was useful for diagnosis. However, chemical analysis of synovial fluid did not provide any information that aided diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Joints, Infection, Joints (Anatomy), Medical examination, Inflammation, Synovial fluid

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Relative toxicity of nonsteroidal anti-inflammatory drugs evaluated

Article Abstract:

Stanford researchers reviewed the treatment of 2747 patients with rheumatoid arthritis using the 11 most frequently prescribed non-steroidal anti-inflammatory drugs (NSAIDS). Indomethacin, tolmetin sodium, meclofenamate sodium and ketoprofen were found to be the most toxic. Coated or buffered aspirin, salsalate and ibuprofen were the least toxic.

Rheumatoid arthritis

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