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Economics
Coxibs were not cost effective for arthritis pain in patients with average risk of ulcer complications

https://doi.org/10.1136/ebm.8.5.159

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    (2003) Ann Intern Med 138, 795. Spiegel BM, Targownik L, Dulai GS, et al.. The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis.. ;. :. –806.
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 QUESTION: In patients with osteoarthritis or rheumatoid arthritis, does the reduction in gastrointestinal (GI) complications seen with coxibs offset their increased cost compared with non-steroidal anti-inflammatory drugs (NSAIDs)?

    Design

    Cost utility analysis using a decision analytic model from the perspective of a third party payer considering direct medical costs.

    Setting

    USA.

    Patients

    A hypothetical cohort of patients 60 years of age with osteoarthritis or rheumatoid arthritis who were not taking aspirin and required NSAID therapy for moderate to severe arthritis pain.

    Intervention

    Patients who entered the model were treated with a coxib (celecoxib, 200 mg once daily, or rofecoxib, 25 mg once daily) or a non-selective NSAID at the maximum dose approved by the US Food and Drug Administration (naproxen, 500 mg twice daily). The model was designed to test the hypothesis that coxibs are cost effective alternatives to NSAIDs.

    Main cost and outcome measures

    A decision tree was constructed to represent the coxib and naproxen strategies. Clinical probability estimates …

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    Footnotes

    • Sources of funding: National Institutes of Health and Veterans Administration.

    • For correspondence: Dr I M Gralnek, Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA. igralnek{at}mednet.ucla.edu

    • Abstract and commentary also appear in ACP Journal Club.