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류마티스 관절염 치료 시 비스테로이드성 소염제 단독 , 위장관 부작용 예방 약제 병용 투여 및 COX - 2 특이 억제제 사용의 한국 비용 - 효과 분석
윤형란(Hyung Ran Yun),(Michael Corzillius),김성윤(Seong Yoon Kim),배상철(Sang Cheol Bae) 대한내과학회 2001 대한내과학회지 Vol.60 No.6
N/A Background : Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) but their use can be associated with gastrointestinal (GI) side effects, which may be prevented with prophylactic prescription of misoprostol and omeprazole. Recently marketed COX-2 specific inhibitor (COX-2) affords protection against gastropathy. This study was performed to assess Korean cost-effectiveness of NSAIDs, NSAIDs with co-treatments to prevent GI toxicity, and COX-2 in the treatment of RA, and compare it with American cost-effectiveness analysis. Methods : Markov (state-transition) models were used to simulate a cohort of RA patients with approximately 2.5:1 female to male ratio and 50 years, taking disease modifying antirheumatic drugs, low dose steroid (prednisone ≤10 mg/day) and one of the following strategies: 1) NSAIDs without prophylaxis, 2) NSAIDs with misoprostol, 3) NSAIDs with proton pump inhibitor (PPI), or 4) COX-2. Data on incidence, USA cost and consequences of adverse events from treatments were taken from the literature. Treatment costs of adverse events in Korea were calculated based on each disease code. Health effects were expressed as quality-adjusted life years (QALYs). Sensitivity analyses of probability of GI complication and cost were performed. Costs and health outcomes were discounted at a rate of 3% per year. Results : Among the strategies to prevent GI toxicity, PPI was the most cost-effective strategy in Korea and COX-2 was in USA, respectively. The incremental C/E (cost/effectiveness) ratio between PPI and no prophylaxis was 38,068×103￦/QALY (32,044$/QALY) in Korea. The incremental
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