Improved Cost-effectiveness Ratio with a Patient Self-adjusted Naproxen Dosing Regimen in Osteoarthritis Treatment

Abstract

A standard fixed dosing regimen (S) and a variable dosing regimen (VD) of naproxen for patients with knee and hip osteoarthritis were compared in a multicentre, open, controlled, parallel 8-week trial. The daily dose of naproxen (Naprosyn) in the S-group was 500-1000 mg, in VD maximum daily dose was 1000 mg. The number of patients entering the study was 396 (286 females). Mean (SD) age was 67 (10) and 67 (11) years in the S- and VD-groups respectively. The number of patients available for efficacy analyses, including the withdrawals, was 356. Efficacy measures included pain on movement, night pain, morning stiffness, a functional index and patient's and doctor's overall assessments. Similar improvement was seen in both groups. The number of patients withdrawn due to adverse reactions in S and VD was 35 and 23 respectively (p less than 0.05). Group differences in drug consumption were highly significant (p less than 0.01) with a 20-30% lower consumption in the VD-group. Thus, similar efficacy and possibly better tolerance was obtained with a lower drug consumption by a variable dosing regimen compared to a fixed regimen.

Second-line drug therapy for osteoarthritis

“…Additionally, the magnitude of improvement in joint pain achieved today with first-line agents is only modest. Based on measurements on visual analogue scales, improvement in joint pain with the currently available agents is only 20-25%, while that with placebo may be 15% [24][25][26][27] . This may account for the observation that only about 15% of patients with OA who were started on an NSAID were still taking the same NSAID 12 months later 28 .…”

Pain management in osteoarthritis: A focus on onset of efficacy—a comparison of rofecoxib, celecoxib, acetaminophen, and nabumetone across four clinical trials

“…1 Characterized by episodic intense pain, flares are usually provoked by excessive and unaccustomed degrees of physical activity. 1,17,21,22,38 They also can occur after periods of inactivity, especially during recumbency (night pain). Patients often begin chronic treatment for OA during a flare or adopt an "as needed" approach to therapy, taking medication only during flares.…”

Economic evaluation of care for the chronically ill

“…49 In general, many behavioural and education programmes for diabetes seem to be cost-beneficial, ^although there is little really strong evidence and some questions remain Three studies focused on medication, 2 for patients with rheumatoid arthritis 58159 and 1 for patients widi osteoarthritis. 60 Thompson et al 58 evaluated the cost-effectiveness of auranofin (an oral gold preparation) in a randomized trial of RA patients with a placebo control group and found significant, albeit slight, improvements in 4 out of 6 clinical outcome parameters and 1 negative side-effect (diarrhoea). However, medical costs (including paid help) and indirect costs (travelling time of patients and work disability) were higher for the experimental group.…”