Cost-effectiveness in medicine is an important issue for health care practitioners in particular and to society in general. We welcome scientific discourse on this issue so that the medical community can make informed decisions. There are several issues that we feel need clarification in the recent article by Stucki et al1 regarding the cost-effectiveness of misoprostol.
The authors suggest that misoprostol (Cytotec) has been promoted as a "routine" medication for patients who are receiving long-term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs). On the contrary, misoprostol is indicated for the prevention of NSAID-induced ulcers in patients who have certain risk factors such as advanced age, history of peptic ulcer disease, and the presence of comorbid conditions.2,3 Moreover, the use of a combination of a NSAID and misoprostol (Arthrotec, available outside the United States) is not intended to promulgate the "routine" use of misoprostol, but rather to improve compliance.