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137 HOW DOES THE COST-EFFECTIVENESS OF GASTROINTESTINAL PROPHYLAXIS THERAPIES IN PREVENTING NSAID-INDUCED ULCER COMPLICATIONS VARY WITH AGE? C Cameron1, S Veldhuyzen van Zanten2, C Skedgel3, I Sketris4, G Flowerdew1 OBJECTIVE: Determine the relationship between age and cost-effectiveness of alternative gastrointestinal prophylaxis strategies.
1Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia; 2Faculty of Medicine, University of Alberta, Edmonton, Alberta; 3Faculty of Medicine, Dalhousie University; 4College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
METHODS: A cost-utility analysis, using a decision tree approach (TreeAge 2005), was developed to evaluate gastrointestinal prophylaxis strategies in a hypothetical cohort of incident-NSAID users age => 65 and age => 75. Patients entering the model were treated with either: (1) No Prophylaxis, (2) standard dose Proton Pump Inhibitors (Rabeprazole 20mg) (3) misoprostol (200µg bid), (4) misoprostol (200µg qid), (5) ranitidine (150mg bid), (6) ranitidine (300mg bid). Event rates were obtained from systematic reviews and meta-analyses, cost effectiveness analyses, and RCTs. Costs were from the perspective of the Nova Scotia Department of Health. Cost utility was measured in terms of cost per Quality adjusted Life Year (QALY) gained relative to no prophylaxis. Probabilistic sensitivity analysis was used to incorporate uncertainty, along with cost-effectiveness acceptability curves.
RESULTS: Misoprostol (200µg bid) and standard dose PPI are more effective and less costly than ranitidine (150mg bid) and ranitidine (300mg bid), respectively. At a willingness to pay of $50,000 per QALY, Misoprostol (200µg, qid) has the highest likelihood of being the cost-effective strategy in the age => 65 cohort (assuming an intolerance rate of 13.9% for misoprostol (200µg, qid)) while standard dose PPI has the highest likelihood of being the cost-effectiveness strategy in the age => 75 cohort.
CONCLUSION: The economically preferred strategy is dependent upon age and decision maker's willingness to pay. As age and willingness to pay increase, the likelihood that standard dose PPI is the most cost-effective strategy increases. Results are dependent upon base-case estimates obtained from RCTs and may differ in the 'real world' where low levels of prescribing and non-adherence to therapies have been reported.