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Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis.
Int J Technol Assess Health Care. 2009 Apr; 25(2):190-5.IJ

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.

Authors+Show Affiliations

University Pharmacy Department of Pharmacy Administration, Semmelweis University, Hogyes Endre. 7-9, Budapest, 1092, Hungary. inotai.andras@freemail.huNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19366498

Citation

Inotai, András, and Agnes Mészáros. "Economic Evaluation of Nonsteroidal Anti-inflammatory Drug Strategies in Rheumatoid Arthritis." International Journal of Technology Assessment in Health Care, vol. 25, no. 2, 2009, pp. 190-5.
Inotai A, Mészáros A. Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis. Int J Technol Assess Health Care. 2009;25(2):190-5.
Inotai, A., & Mészáros, A. (2009). Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis. International Journal of Technology Assessment in Health Care, 25(2), 190-5. https://doi.org/10.1017/S0266462309090242
Inotai A, Mészáros A. Economic Evaluation of Nonsteroidal Anti-inflammatory Drug Strategies in Rheumatoid Arthritis. Int J Technol Assess Health Care. 2009;25(2):190-5. PubMed PMID: 19366498.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic evaluation of nonsteroidal anti-inflammatory drug strategies in rheumatoid arthritis. AU - Inotai,András, AU - Mészáros,Agnes, PY - 2009/4/16/entrez PY - 2009/4/16/pubmed PY - 2009/6/24/medline SP - 190 EP - 5 JF - International journal of technology assessment in health care JO - Int J Technol Assess Health Care VL - 25 IS - 2 N2 - 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. SN - 1471-6348 UR - https://www.unboundmedicine.com/medline/citation/19366498/Economic_evaluation_of_nonsteroidal_anti_inflammatory_drug_strategies_in_rheumatoid_arthritis_ L2 - https://www.cambridge.org/core/product/identifier/S0266462309090242/type/journal_article DB - PRIME DP - Unbound Medicine ER -