Switching NSAIDs wastes money

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Rheumawire

June 10, 2004 Zosia Chustecka

Switching NSAIDs wastes money

Berlin, Germany - A study that has quantified the amount wasted by

switching from 1 anti-inflammatory drug to another has shown that the

cost is twice as high for a nonselective nonsteroidal anti-inflammatory

drug (NSAID) compared with the selective COX-2 inhibitors celecoxib

(Celebrex®, Pfizer) and rofecoxib (Vioxx®, Merck & Co).

" Physicians should inquire more closely about gastrointestinal risk

factors, such as whether patients are on corticosteroids or whether they

have an ulcer, as patients with these risk factors switch more often

than those who do not have them, " says the lead researcher, Dr Elham

Rahme (McGill University, Montreal, QC). " Taking care to prescribe the

treatment most suited to the individual patient will help to conserve

healthcare resources. "

Rahme presented the data in an oral presentation here at the EULAR 2004

meeting [1]. It comes from a retrospective cohort study using data from

the health insurance agency Régie de l'assurance maladie du Québec

(RAMQ) and was partly funded by Merck & Co. The researchers identified

4592 seniors (aged 65 years or more) with chronic pain who had started

using NSAIDs or coxibs during 2001. " These were first-time but likely to

be chronic users, " Rahme commented. Switching was defined as filling a

prescription different from the first drug they used before the supply

of the first drug had run out.

The adjusted rate of switching was lower among both coxib groups

compared with the NSAIDs, with a hazard ratio of 0.39 (95% CI 0.3-0.5)

for rofecoxib and 0.41 (95% CI 0.32-0.54) for celecoxib vs the

nonselective NSAIDs. This means the chance of switching was about 60%

lower in the coxib groups compared with NSAIDs, Rahme commented.

The researchers then calculated the costs associated with switching,

adding the cost of wasted medication with the cost of an extra visit to

the physician for the new prescription. For NSAIDs, these wasted

resources amounted to Can $4.61 per prescription compared with Can $2.42

for celecoxib and Can $2.22 for rofecoxib.

" Patients on coxibs switch less often than those on NSAIDs, and the cost

of wasted resources is twice as high in NSAID users compared with coxib

users, " Rahme concluded.

The researchers also found that patients who were using corticosteroids

had 57% more risk of switching medication compared with patients who

weren't on steroids. In addition, patients between 75 and 84 years of

age were 24% more likely to switch medication compared with younger

patients.

" Switching medications within the same therapeutic class may indicate

dissatisfaction with the medication, when a patient complains that the

drug is not effective or that he or she is experiencing side effects, "

Rahme commented. It's important to identify why patients want to switch

their medications so that it can, in part, be prevented, she added.

Selecting appropriate therapies for patients can improve healing time

and quality of life, as well as decreasing the overall treatment cost.

Source

Rahme E, Toubouti Y, Hunsche E, et al. Therapy

switching and associated costs in patients on selective cox-2 inhibitors

and non-selective NSAIDs in an elderly population in Quebec, Canada.

Presented at: EULAR 2004; Berlin, Germany; June 9-12, 2004. Abstract

OP0059.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org