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

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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.

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Notes

  1. The cost diaries that were missing were from patients who either discontinued treatment or failed to return the cost diaries.

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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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Authors and Affiliations

  1. Department of Clinical Epidemiology & Biostatistics, Vrije Universiteit medisch centrum, Van de Boechorststraat 7, 1081 BT, Amsterdam, Netherlands

    Hiske E. M. van Dieten, Maurits W. van Tulder, Herman J. Ader & Maarten Boers

  2. Department of Anesthesiology, Vrije Universiteit Medisch Centrum, Amsterdam, Netherlands

    Roberto S. G. M. Perez, Jaap J. de Lange & Wouter W. A. Zuurmond

  3. Department of Health Economics, University of Southern Denmark, Odense, Denmark

    Hindrik Vondeling

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  1. Hiske E. M. van Dieten
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  2. Roberto S. G. M. Perez
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  4. Jaap J. de Lange
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  5. Wouter W. A. Zuurmond
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van Dieten, H.E.M., Perez, R.S.G.M., van Tulder, M.W. et al. Cost Effectiveness and Cost Utility of Acetylcysteine versus Dimethyl Sulfoxide for Reflex Sympathetic Dystrophy. Pharmacoeconomics 21, 139–148 (2003). https://doi.org/10.2165/00019053-200321020-00006

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