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PharmacoEconomics

, Volume 21, Issue 2, pp 139–148 | Cite as

Cost Effectiveness and Cost Utility of Acetylcysteine versus Dimethyl Sulfoxide for Reflex Sympathetic Dystrophy

  • Hiske E. M. van Dieten
  • Roberto S. G. M. Perez
  • Maurits W. van Tulder
  • Jaap J. de Lange
  • Wouter W. A. Zuurmond
  • Herman J. Ader
  • Hindrik Vondeling
  • Maarten Boers
Original Research Article

Abstract

Objective: To determine the cost effectiveness and cost utility of acetylcysteine versus dimethyl sulfoxide (DMSO) for patients with reflex sympathetic dystrophy (RSD), from a societal viewpoint.

Design: An economic evaluation was conducted alongside a double-dummy, double-blind, randomised, controlled trial. Patients were followed for 1 year. The primary outcome measure was the Impairment-level Sum Score (ISS). Utilities were determined by the EuroQOL instrument (EQ-5D). Both cost-effectiveness and cost-utility analyses were performed. Differences in mean direct, indirect and total costs were estimated. Corresponding 95% confidence intervals were calculated by bootstrapping techniques.

Results: Both groups (DMSO, n = 64; acetylcysteine, n = 67) showed relevant improvement; no differences in effects were found. Only the total direct costs were significantly lower in the DMSO group for the period of 0–52 weeks. The incremental cost-effectiveness ratios showed that, in general, DMSO generated fewer costs and more effects compared with acetylcysteine. Post-hoc subgroup analyses on cost effectiveness suggested that patients with warm RSD could be best treated with DMSO and patients with cold RSD with acetylcysteine. These results were based on small subsamples.

Conclusion: In general, DMSO is the preferred treatment for patients with RSD.

Keywords

Spinal Cord Stimulation Acetylcysteine Reflex Sympathetic Dystrophy Pharmacoeconomic Evaluation Travel Expense 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The source of financial support for this economic evaluation was given by the fund of investigative medicine of the Health Insurance Council (OG: 96-014). The authors have provided no information on conflicts of interest directly relevant to the content of this study.

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Copyright information

© Adis International Limited 2003

Authors and Affiliations

  • Hiske E. M. van Dieten
    • 1
  • Roberto S. G. M. Perez
    • 2
  • Maurits W. van Tulder
    • 1
  • Jaap J. de Lange
    • 2
  • Wouter W. A. Zuurmond
    • 2
  • Herman J. Ader
    • 1
  • Hindrik Vondeling
    • 3
  • Maarten Boers
    • 1
  1. 1.Department of Clinical Epidemiology & BiostatisticsVrije Universiteit medisch centrumAmsterdamNetherlands
  2. 2.Department of AnesthesiologyVrije Universiteit Medisch CentrumAmsterdamNetherlands
  3. 3.Department of Health EconomicsUniversity of Southern DenmarkOdenseDenmark

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