Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-04T21:34:58.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis

Published online by Cambridge University Press:  15 April 2009

András Inotai  and
Ágnes Mészáros
András Inotai
Affiliation:
Semmelweis University
Ágnes Mészáros
Affiliation:
Semmelweis University
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Although disease modifying antirheumatic drugs (DMARDs) are the first choice drugs in the treatment of rheumatoid arthritis, many patients still take nonsteroidal anti-inflammatory drugs (NSAIDs) as well. These drugs may cause serious gastric adverse events with continuous usage. Cyclooxygenase-2 (COX2) inhibitors were supposed to have a gastrointestinal (GI) friendly side effect profile. The aim of the study is to compare three therapeutic strategies: conventional NSAIDs, NSAID in combination with proton pump inhibitors (PPIs), and the selective COX2 inhibitor therapy (celecoxib).

Methods: A decision tree model was developed, for 1 year, to simulate cohorts within the three arms (NSAIDs, NSAID + PPI, celecoxib). The efficacy of the different active agents of NSAIDs in therapeutically relevant doses was assumed to be the same, consequently differences can be seen in the side effect profile of the drugs. Medical costs, the costs of the side effects (GI, cardiovascular [CV] events), and quality-adjusted life-years (QALYs) were calculated to gain an incremental cost-effectiveness ratio (ICER). Evaluations were made from a third party payer's perspective. We performed one-way deterministic sensitivity analyses; the results were displayed in tornado diagrams.

Results: Our model indicates that NSAID + PPI offers extra health gain for extra costs compared with conventional NSAIDs (ICER:14,287 euro/QALY), while it dominates celecoxib because of celecoxib's higher costs and lower effectiveness. According to the sensitivity analyses, QALYs had the highest influence on ICER.

Conclusions: Although COX2 inhibitors have elevated GI efficacy compared with NSAIDs, celecoxib seems to be an adequate choice only for a limited group of patients with specific conditions because of the significantly higher price and CV risk profile.

Keywords

Cost-effectivenessCOX2 inhibitorsRheumatoid arthritisDecision tree
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 2 , April 2009 , pp. 190 - 195
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Cantor, SB. Pharmacoeconomics of coxib therapy. J Pain Symptom Manage. 2002;24 (Suppl):S28–S37.CrossRefGoogle ScholarPubMed
2. Coruzzi, G, Venturi, N, Spaggiari, S. Gastrointestinal safety of novel non-steroidal anti-inflammatory drugs: Selective COX-2 inhibitors and beyond. Acta Biomed. 2007;78:96–110.Google ScholarPubMed
3. Dai, C, Stafford, RS, Alexander, GC. National trends in cyclooxygenase-2 inhibitor use since market release: Nonselective diffusion of a selectively cost-effective innovation [see comment]. Arch Intern Med. 2005;165:171–177.CrossRefGoogle ScholarPubMed
4. Drummond, MF, Schulper, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. Oxford: Oxford University Press; 2005.Google Scholar
5. El-Serag, HB, Graham, DY, Richardson, P, Inadomi, JM. Prevention of complicated ulcer disease among chronic users of non-steroidal anti-inflammatory drugs: The use of a nomogram in cost-effectiveness analysis. Arch Intern Med. 2002;162:2105–2110.CrossRefGoogle ScholarPubMed
6. Fleischmann, R, Tannenbaum, H, Patel, NP et al. , Long-term retention on treatment with lumiracoxib 100 mg once or twice daily compared with celecoxib 200 mg once daily: A randomised controlled trial in patients with osteoarthritis. BMC Musculoskelet Disord. 2008;9:32.CrossRefGoogle ScholarPubMed
7. Hungarian DRG system [HBCs 5.0]. http://www.eski.hu/new3/adatok/kodok/HBCs_5.0_torzs.htm. Accessed August 5, 2008.Google Scholar
8. Hungarian drug formulary Pharmindex. http://www.pharmindex.hu/gyogyszer-kereso.xhtml. Accessed August 5, 2008.Google Scholar
9. Indicators of the treatment of AMI. 30 days rough mortality. (AMI kórházi ellátásának indikátorai. 30 napos nyers halálozás. 2006. November). http://www.oep.hu/portal/page?_pageid=6,33139&_dad=portal&_schema=PORTAL. Accessed February 2, 2008.Google Scholar
10. Indicators of the treatment of AMI. Ratios of different cardiologic interventions in the treatment of AMI. (AMI kórházi ellátásának indikátorai. Kardiológiai beavatkozásban részesültek aránya az AMI esetek körében. 2006. November). http://www.oep.hu/portal/page?_pageid=6,33139&_dad=portal&_schema=PORTAL. Accessed February 2, 2008.Google Scholar
11. Laine, L. Gastrointestinal effects of NSAIDs and coxibs. J Pain Symptom Manage. 2003;25 (Suppl):S32-S40.CrossRefGoogle ScholarPubMed
12. Loyd, M, Rublee, D, Jacobs, P. An economic model of long-term use of celecoxib in patients with osteoarthritis. BMC Gastroenterol. 2007;7:25.CrossRefGoogle ScholarPubMed
13. Maetzel, A, Ferraz, MB, Bombardier, C. The cost-effectiveness of misoprostol in preventing serious gastrointestinal events associated with the use of non-steroidal anti-inflammatory drugs [see comment]. Arthritis Rheum. 1998;41:16–25.3.0.CO;2-4>CrossRefGoogle Scholar
14. Maetzel, A, Krahn, M, Naglie, G. The cost effectiveness of rofecoxib and celecoxib in patients with osteoarthritis or rheumatoid arthritis. Arthritis Rheum. 2003;49:283–292.CrossRefGoogle ScholarPubMed
15. NICE. Cyclooxygenase-2 (COX-2) selective non-steroidal anti-inflammatory drugs – etodolac, meloxicam, celecoxib, rofecoxib, valdecoxib and etoricoxib – for osteoarthritis and rheumatoid arthritis: A systematic review and economic evaluation. http://www.nice.org.uk/guidance/index.jsp?action=download&o=34820. Accessed August 5, 2008.Google Scholar
16. Péntek, M, Szekanecz, Z, Czirják, L et al. , Impact of disease progression on health status, quality of life and costs in rheumatoid arthritis in Hungary [A betegség progresszió hatása az egészségi állapotra, életminőségre és költségekre rheumatoid arthritisben Magyarországon]. Orvosi Hetilap. 2008;149:733–741.CrossRefGoogle ScholarPubMed
17. Protocol of the Ministry of Health, Hungary – Pharmacological treatment of pain and inflammation in rheumatic diseases. (Az Egészségügyi Minisztérium szakmai protokollja – Gyógyszeres fájdalomcsillapítás és gyulladásgátlás a reumatológiai betegségekben) http://www.eum.hu/egeszsegpolitika/minosegfejlesztes/reumatologia. Accessed August 5, 2008.Google Scholar
18. Ray, WA, Chung, CP, Stein, CM et al. , Risk of peptic ulcer hospitalizations in users of NSAIDs with gastroprotective cotherapy versus coxibs. Gastroenterology. 2007;133:790–798.CrossRefGoogle ScholarPubMed
19. Silverstein, FE, Faich, G, Goldstein, JL. Gastrointestinal toxicity with celecoxib vs. non-steroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: The CLASS study: A randomized controlled trial. JAMA. 2000;284:1247–1255.CrossRefGoogle ScholarPubMed
20. Spiegel, BMR, Chiou, CF, Ofman, JJ. Minimizing complications from non-steroidal anti-inflammatory drugs: Cost-effectiveness of competing strategies in varying risk groups.[see comment]. Arthritis Rheum. 2005;53:185–197.CrossRefGoogle ScholarPubMed
21. Yun, HR, Bae, SC. Cost-effectiveness analysis of NSAIDs, NSAIDs with concomitant therapy to prevent gastrointestinal toxicity, and COX-2 specific inhibitors in the treatment of rheumatoid arthritis. Rheumatol Int. 2005;25:9–14.CrossRefGoogle ScholarPubMed
Supplementary material: File

Inotai supplementary material

Tables and figures

Download Inotai supplementary material(File)
File 142.3 KB