Role of initial NSAID choice and patient risk factors in the prevention of NSAID gastropathy: a decision analysis

Arthritis and Rheumatism
A Mark FendrickJames M Scheiman

Abstract

To investigate the role of initial nonsteroidal antiinflammatory drug (NSAID) choice in the prevention of NSAID gastropathy, based on relative clinical and economic effects. To mimic clinical practice, a symptom-driven decision analytic model was constructed to compare 2 treatment strategies for long-term users of NSAIDs over a 1-year period: Strategy 1-generic NSAID used initially, and safer, more expensive NSAID reserved for treatment failures due to symptomatic gastropathy; and Strategy 2-safer, more expensive NSAID used in all instances. The only distinction between the strategies was the choice of initial NSAID. NSAIDs differed in gastrointestinal safety profiles and acquisition costs. The use and impact of antisecretory medications were included in the model. Because published data on patients' ulcer risk and relative NSAID safety show considerable variability, sensitivity analyses were used to evaluate the key clinical outcomes and costs. For patients without risk factors for NSAID ulcers (average risk), the model estimated that the strategy restricting use of the safer NSAID resulted in more symptomatic ulcers (Strategy 1, 2.58; Strategy 2, 0.73) and ulcer-related complications (Strategy 1, 1.18; Strategy 2, 0.23) per 1...Continue Reading

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Citations

Oct 13, 2006·Current Opinion in Gastroenterology·Barbara M AldermanNeville D Yeomans
Nov 12, 2013·Applied Health Economics and Health Policy·Ronald C WielageMichael Happich
Mar 30, 2005·Expert Opinion on Drug Safety·Sia Peng, Anne Duggan
Jan 26, 2010·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Neena S AbrahamJennifer Hasche
May 19, 2009·Gastroenterology Clinics of North America·James M Scheiman
May 15, 2007·Lancet·James M Scheiman, A Mark Fendrick
Jun 5, 2004·The American Journal of Medicine·Joshua J OfmanLoren Laine
Oct 30, 2016·Clinical Therapeutics·Deirdre MladsiKenneth Saag
Mar 20, 2004·The Annals of Pharmacotherapy·Ron M C Herings, Wim G Goettsch
Oct 3, 2002·The American Journal of Gastroenterology·James M Scheiman, A Mark Fendrick
Oct 18, 2006·Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases·James M Scheiman, A Mark Fendrick
Nov 13, 2002·Pharmacoepidemiology and Drug Safety
Oct 9, 2004·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Elham RahmeMarc Bardou
Dec 6, 2006·Expert Review of Neurotherapeutics·Neal M DaviesKarina R Vega-Villa
Oct 1, 2008·Expert Review of Pharmacoeconomics & Outcomes Research·C Daniel MullinsFlorian Turk

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