The cost effectiveness of rofecoxib and celecoxib in patients with osteoarthritis or rheumatoid arthritis

Abstract

Objective. To evaluate the cost effectiveness of the cyclooxygenase 2 (COX-2) selective nonsteroidal antiinflammatory drug (NSAID) rofecoxib compared with naproxen and the COX-2 NSAID celecoxib compared with ibuprofen and diclofenac. Methods. Cost-effectiveness analysis based on a 5-year Markov model. Probability estimates were derived from detailed data of 2 randomized trials and a systematic search of the medical literature. Utility estimates were obtained from 60 randomly selected members of the general public. Cost estimates were obtained from Canadian provincial databases. Incremental cost-effectiveness ratios were calculated for patients at average risk of upper gastrointestinal (UGI) events and for high-risk patients with a prior history of a UGI event. Subjects were patients with osteoarthritis or rheumatoid arthritis (RA) where a decision has been made to treat with NSAIDs but who do not require low-dose aspirin. Main outcome measures were proportion of patients with clinical or complicated UGI events, quality-adjusted life expectancy, and life expectancy. Results. Evaluation of rofecoxib versus naproxen in patients with RA at average risk resulted in costs per qualityadjusted life year (QALY) gained of $Can271,188. Celecoxib was dominated by diclofenac in average-risk patients. Both rofecoxib and celecoxib are cost-effective in high-risk patients. Analyses by age groups and assuming a threshold of Can$50,000 per QALY gained, suggest that rofecoxib or celecoxib would be cost-effective in patients aged over 76 and 81, respectively, without additional risk factors. Conclusion. Both rofecoxib and celecoxib are economically attractive in high risk and elderly patients. They are not economically attractive in patients at average risk. Coprescription of proton-pump inhibitors with COX-2 NSAIDs is not economically attractive for patients at high risk.

Cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation

“…All of these analyses gave results that were less attractive for COX-2 selective NSAIDs. Most of these studies considered a longer time horizon; for example, lifetime in the case of Spiegel and colleagues 298 and 5 years in the cases of Maetzel and colleagues 299 and Rafter and colleagues 300 (see Appendix 8).…”

“…Nevertheless, the inclusion of CV events would result in COX-2 selective NSAIDs being less cost-effective. 299 are given in Table 59. The costs and QALY estimates are for an average patient over a 5-year time horizon.…”

Retrospective analysis of utilization patterns and cost implications of coxibs among seniors in Quebec, Canada: What is the potential impact of the withdrawal of rofecoxib?

“…The total daily drug costs of coxibs are also impacted by the prophylactic use of GPAs (33). In this study of coxib recipients, patients who received rofecoxib were 12% less likely to fill a GPA coprescription at the index date than were those who received celecoxib.…”

Impact of disease severity and gastrointestinal side effects on the health state preferences of patients with osteoarthritis

“…All NSAIDs are associated with side effects. Patients' ratings of OA health states and/or side effects from medications have not been reported widely in the literature, and few studies in any therapeutic area have examined the influence of treatment-related side effects on patients' assessments of health states or health utilities, a concept similar to health-related quality of life (5)(6)(7)(8). Researchers generally have studied side effects as separate health states (e.g., dyspepsia) without considering the combined effects of both disease severity and side effect severity (5)(6)(7)9).…”

“…Patients' ratings of OA health states and/or side effects from medications have not been reported widely in the literature, and few studies in any therapeutic area have examined the influence of treatment-related side effects on patients' assessments of health states or health utilities, a concept similar to health-related quality of life (5)(6)(7)(8). Researchers generally have studied side effects as separate health states (e.g., dyspepsia) without considering the combined effects of both disease severity and side effect severity (5)(6)(7)9). Because side effects may affect patients' overall well-being substantially, an understanding of health state preferences across levels of OA severity and profiles of treatment-related side effects will allow for better assessment of new and existing OA therapies, and will inform patient and physician decision making (8,10,11).…”