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Minimizing complications from nonsteroidal antiinflammatory drugs: cost-effectiveness of competing strategies in varying risk groups.
Arthritis Rheum. 2005 Apr 15; 53(2):185-97.AR

Abstract

OBJECTIVE

To appraise the cost-effectiveness of competing therapeutic strategies in patient cohorts eligible for aspirin prophylaxis with varying degrees of gastrointestinal (GI) and cardiovascular risk.

METHODS

Cost-effectiveness and cost-utility analyses were performed to evaluate 3 competing strategies for the management of chronic arthritis: 1) a generic nonselective nonsteroidal antiinflammatory drug (NSAID(NS)) alone; 2) NSAID(NS) plus a proton pump inhibitor (PPI); and 3) a cyclooxygenase 2-selective inhibitor (coxib) alone. Cost estimates were from a third-party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use.

RESULTS

In average-risk patients, the NSAID(NS) + PPI strategy costs an incremental 45,350 US dollars per additional ulcer complication avoided and 309,666 US dollars per QALY gained compared with the NSAID(NS) strategy. The coxib strategy was less effective and more expensive than the NSAID(NS) + PPI strategy. Sensitivity analysis revealed that the NSAID(NS) + PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with > or =1 risk factor for a GI complication).

CONCLUSION

Generic nonselective NSAIDs are most cost-effective in patients at low risk for an adverse event. However, the addition of a PPI to a nonselective NSAID may be the preferred strategy in patients taking aspirin or otherwise at high risk for a GI or cardiovascular adverse event.

Authors+Show Affiliations

Veteran's Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 90073, USA. bspiegel@mednet.ucla.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

15818647

Citation

Spiegel, Brennan M R., et al. "Minimizing Complications From Nonsteroidal Antiinflammatory Drugs: Cost-effectiveness of Competing Strategies in Varying Risk Groups." Arthritis and Rheumatism, vol. 53, no. 2, 2005, pp. 185-97.
Spiegel BM, Chiou CF, Ofman JJ. Minimizing complications from nonsteroidal antiinflammatory drugs: cost-effectiveness of competing strategies in varying risk groups. Arthritis Rheum. 2005;53(2):185-97.
Spiegel, B. M., Chiou, C. F., & Ofman, J. J. (2005). Minimizing complications from nonsteroidal antiinflammatory drugs: cost-effectiveness of competing strategies in varying risk groups. Arthritis and Rheumatism, 53(2), 185-97.
Spiegel BM, Chiou CF, Ofman JJ. Minimizing Complications From Nonsteroidal Antiinflammatory Drugs: Cost-effectiveness of Competing Strategies in Varying Risk Groups. Arthritis Rheum. 2005 Apr 15;53(2):185-97. PubMed PMID: 15818647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimizing complications from nonsteroidal antiinflammatory drugs: cost-effectiveness of competing strategies in varying risk groups. AU - Spiegel,Brennan M R, AU - Chiou,Chiun-Fang, AU - Ofman,Joshua J, PY - 2005/4/9/pubmed PY - 2005/5/6/medline PY - 2005/4/9/entrez SP - 185 EP - 97 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 53 IS - 2 N2 - OBJECTIVE: To appraise the cost-effectiveness of competing therapeutic strategies in patient cohorts eligible for aspirin prophylaxis with varying degrees of gastrointestinal (GI) and cardiovascular risk. METHODS: Cost-effectiveness and cost-utility analyses were performed to evaluate 3 competing strategies for the management of chronic arthritis: 1) a generic nonselective nonsteroidal antiinflammatory drug (NSAID(NS)) alone; 2) NSAID(NS) plus a proton pump inhibitor (PPI); and 3) a cyclooxygenase 2-selective inhibitor (coxib) alone. Cost estimates were from a third-party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use. RESULTS: In average-risk patients, the NSAID(NS) + PPI strategy costs an incremental 45,350 US dollars per additional ulcer complication avoided and 309,666 US dollars per QALY gained compared with the NSAID(NS) strategy. The coxib strategy was less effective and more expensive than the NSAID(NS) + PPI strategy. Sensitivity analysis revealed that the NSAID(NS) + PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with > or =1 risk factor for a GI complication). CONCLUSION: Generic nonselective NSAIDs are most cost-effective in patients at low risk for an adverse event. However, the addition of a PPI to a nonselective NSAID may be the preferred strategy in patients taking aspirin or otherwise at high risk for a GI or cardiovascular adverse event. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/15818647/Minimizing_complications_from_nonsteroidal_antiinflammatory_drugs:_cost_effectiveness_of_competing_strategies_in_varying_risk_groups_ L2 - https://doi.org/10.1002/art.21065 DB - PRIME DP - Unbound Medicine ER -