An economic model for determining the costs and consequences of using various treatment alternatives for the management of arthritis in Canada.
OBJECTIVE
To construct a decision analytical model to compare the costs and clinical consequences of treating patients with celecoxib or various nonsteroidal anti-inflammatory drug (NSAID)/gastrointestinal (GI) co-therapy regimens for the management of osteoarthritis and rheumatoid arthritis. The model quantified the number of patients expected to experience any GI complication commonly associated with NSAID therapy.


METHODS
Resource use for the treatment of each GI complication in the model was estimated after consulting Canadian experts. Standard unit costs from Ontario were applied to resources to calculate the cost of each complication.


RESULTS
The model revealed that the NSAID-alone regimen was associated with the lowest cost [$262 Canadian dollars ($Can) per patient per 6 months] followed by the celecoxib regimen ($Can273), diclofenac/misoprostol ($Can365), NSAID + histamine H2 receptor antagonist ($Can413), NSAID + misoprostol ($Can421), and NSAID + proton pump inhibitor ($Can731). A break-even analysis showed that up to 80% of the study cohort could be treated with celecoxib instead of the NSAID-alone regimen without increasing the health system's overall budget. Celecoxib was associated with the fewest GI-related deaths, hospitalised events; symptomatic ulcers, and cases of anaemia. The celecoxib regimen was also associated with the fewest cases of upper GI distress. Sensitivity analyses revealed that the model was most sensitive to the distribution of GI risk in the population and to the ingredient costs of the treatment alternatives.


CONCLUSIONS
This model indicates that the use of celecoxib could lead to the avoidance of a significant number of NSAID-attributable GI adverse events, and the incremental cost of using celecoxib for arthritis patients > or = 65 years of age in place of current treatment alternatives would not impose an excessive incremental impact on a Canadian provincial healthcare budget.
Pharmacia Corporation, Global Health Outcomes, Skokie, Illinois, USA.
R A
RA
Zabinski
T A
TA
Burke
J
J
Johnson
F
F
Lavoie
C
C
Fitzsimon
R
R
Tretiak
J V
JV
Chancellor
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D002170:Canada; D017281:Cost of Illness; D003663:Decision Trees; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics; D017850:Economics, Pharmaceutical; D006760:Hospitalization / Q000191:economics; D006801:Humans; D018803:Models, Economic; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents