Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug—Induced Gastropathy in Patients With Chronic Arthritis?

Whether misoprostol, a synthetic prostaglandin E1 analogue, should
be routinely prescribed along with nonsteriodal anti-inflammatory
drugs (NSAIDS) to prevent gastric damage is of great clinical
importance and has profound cost implications. No consensus exists
on whether misoprostol cotherapy results in a cost-saving, is
cost-effective, or is costly. The different conclusions reached by
five economic evaluations of misoprostol can be explained solely by
the assumed absolute risk reduction of symptomatic ulcer, which was
more than seven times greater in the studies that concluded that
misoprostol was cost-effective than in a study that concluded
misoprostol to be costly. Since no study has directly shown the
effectiveness of misoprostol cotherapy in preventing clinically
significant ulcer disease (ie, hemorrhage and preforation), it is
impossible to judge which assumptions are most appropriate. The
absence of firm data on the rate of NSAID-induced gastric ulcers
reduced by misoprostol makes it impossible to conclude whether it
is cost-effective in patients with chronic arthritis who use
NSAIDS.