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Has the Cost-effectiveness of Misoprostol Been Underestimated?

Sherine E. Gabriel, MD, MSc
Arch Intern Med. 1995;155(13):1448-1451. doi:10.1001/archinte.1995.00430130142017.
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In the recent review article, "Is Misoprostol Cost-effective in the Prevention of Nonsteroidal Anti-inflammatory Drug—Induced Gastropathy in Patients With Chronic Arthritis?" Stucki et al1 overlooked an important criticism regarding the calculation of the probability of gastrointestinal tract hemorrhage that appeared in an article by Edelson et al.2 In that study, the probability estimates for gastrointestinal tract hemorrhage for the "overall" category were derived using an estimate of population attributable fraction (PAF). The PAF is defined as the proportion of all cases (upper gastrointestinal tract hemorrhage) in the target population attributable to the exposure (nonsteroidal anti-inflammatory drugs) (NSAIDs).3 The prevalence of the exposure in the target population and the relative risk of the exposure determine the PAF, ie, PAF=pe(RR — 1)/pe(RR — 1) + 1, where pe is the prevalence of exposure to NSAIDs and RR is the relative risk of gastrointestinal tract hemorrhage


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