The Cost-Effectiveness of COX-2 Selective Inhibitors in the Management of Chronic Arthritis

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ls of Internal Medicine

Brennan M.R. Spiegel, MD; Targownik, MD; Gareth S. Dulai, MD,

MSHS; and Ian M. Gralnek, MD, MSHS

20 May 2003 | Volume 138 Issue 10 | Pages 795-806

The Cost-Effectiveness of Cyclooxygenase-2 Selective Inhibitors in the

Management of Chronic Arthritis

Background: Rofecoxib and celecoxib (coxibs) effectively treat chronic

arthritis pain and reduce ulcer complications by 50% compared with

nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). However,

their absolute risk reduction is small and the cost-effectiveness of

treatment is uncertain.

Objective: To determine whether the degree of risk reduction in

gastrointestinal complications by coxibs offsets their increased cost

compared with a generic nonselective NSAID.

Design: Cost-utility analysis.

Data Sources: Systematic review of MEDLINE and published abstracts.

Target Population: Patients with osteoarthritis or rheumatoid arthritis

who are not taking aspirin and who require long-term NSAID therapy for

moderate to severe arthritis pain.

Perspective: Third-party payer.

Interventions: Naproxen, 500 mg twice daily, and coxib, once daily.

Patients intolerant of naproxen were switched to a coxib.

Time Horizon: Lifetime.

Outcome Measures: Incremental cost per quality-adjusted life-year (QALY)

gained.

Results of Base-Case Analysis: Using a coxib instead of a nonselective

NSAID in average-risk patients cost an incremental $275 809 per year to

gain 1 additional QALY.

Results of Sensitivity Analysis: The incremental cost per QALY gained

decreased to $55 803 when the analysis was limited to the subset of

patients with a history of bleeding ulcers. The coxib strategy became

dominant when the cost of coxibs was reduced by 90% of the current

average wholesale price. In probabilistic sensitivity analysis, if a

third-party payer was willing to pay $150 000 per QALY gained, then 4.3%

of average-risk patients would fall within the budget.

Conclusions: The risk reduction seen with coxibs does not offset their

increased costs compared with nonselective NSAIDs in the management of

average-risk patients with chronic arthritis. However, coxibs may

provide an acceptable incremental cost-effectiveness ratio in the

subgroup of patients with a history of bleeding ulcers.

http://www.annals.org/cgi/content/abstract/138/10/795

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