Oral prednisolone is more cost-effective than oral indomethacin for treating patients with acute gout-like arthritis

Objectives Acute gouty arthritis is often treated with NSAIDs, but recent studies have suggested that treatment with prednisolone has at least equivalent analgesic efficacy and fewer adverse effects. No formal economic analysis has been performed earlier. In this study, we aimed to compare the economic impact of oral indomethacin therapy and oral prednisolone therapy in the treatment of acute gout in patients presenting to an emergency department in Hong Kong. Methods Data from a previously published randomized controlled trial were used to compare the costs of the two treatment options. Direct, incremental costs incurred in the 2 weeks after the initial presentation were considered from the perspective of the healthcare provider. Costs were subdivided into those incurred in the emergency department phase; admission on day 1 to the emergency department's observation ward; admission subsequently to the general medical ward for adverse events and reattendance to the hospital outpatients' or emergency department. Results The prednisolone strategy resulted in cost savings in the emergency department of HK$5.67 (US$0.73; 0.37) pound and in medical admissions of HK$1727.48 (US$221.47; 111.45) pound per patient treated. Overall, the average saving with prednisolone was HK$1235 (US$158.33; 79.68) pound per patient treated, which was equivalent to one admission bed/day saved for every two patients treated. Treatment for each of the six patients in the indomethacin group admitted for serious adverse effects cost the healthcare provider HK$13 244 (US$1697.95; 854.45) pound. Conclusion Treatment of acute gouty arthritis with a 5-day course of prednisolone is significantly more cost-effective than treatment with indomethacin. European Journal of Emergency Medicine 16:261-266 (c) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.