title: COX-2-specific inhibitors: prescribing patterns in a large managed care health system and strategies to minimize costs.
abstract: OBJECTIVE
  To determine the relative costs associated with the exclusive use of celecoxib versus rofecoxib in a large managed care system.
  
  
  METHODS
  A retrospective review of all calendar year 2000 prescriptions dispensed for celecoxib and rofecoxib in the Veterans Affairs (VA) system.
  
  
  METHODS
  The primary data points included drug strength, quantity dispensed, and days supply for the prescription. The cost minimization model described in Federal Practitioner (1999;16[4]:41-44) was used to calculate the cost savings. The mean once-daily dosing rates and their 95% confidence intervals were determined by binomial data analysis. Calendar year 2001 utilization and cost projections were derived by linear regression trend analysis.
  
  
  RESULTS
  Current VA system costs per dose are celecoxib 100 mg $0.66; celecoxib 200 mg $1.32; rofecoxib (12.5 or 25 mg) $1.32; rofecoxib 50 mg $2.14. During calendar year 2000, the VA spent $13.8 million and $4.2 million on celecoxib and rofecoxib, respectively. The percentage of once-daily or less than once-daily dosing was celecoxib 100 mg (17%), celecoxib 200 mg (67%), celecoxib overall (49%), rofecoxib 12.5 mg (86%), rofecoxib 25 mg (94%), rofecoxib 50 mg (100%), and rofecoxib overall (93%). Based on current utilization, if all celecoxib prescriptions were changed to rofecoxib, the VA would have realized annual cost savings of $2.1 million in calendar year 2000. In calendar year 2001, projected cost savings could total $5.2 million. This potential savings is largely due to the high prevalence of twice-daily celecoxib dosing.
  
  
  CONCLUSIONS
  The results of the cyclooxygenase-2 cost minimization analysis provide a compelling argument for the preferred use of rofecoxib in the VA system, and potentially in other managed care systems.
authors.affiliation: Department of Veterans Affairs, North Texas Health Care System, Dallas 75216, USA. Rick.Weideman@med.va.gov
authors.forename: Rick A
authors.initials: RA
authors.lastname: Weideman
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Kelly
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Kelley
authors.forename: Byron
authors.initials: B
authors.lastname: Cryer
mesh_terms: D000068579:Celecoxib; D003363:Cost Control; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D017723:Drug Utilization Review; D006302:Health Services Research; D006801:Humans; D007527:Isoenzymes / Q000187:drug effects; D007783:Lactones / Q000191:economics / Q000627:therapeutic use*; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration; D008565:Membrane Proteins; D010818:Practice Patterns, Physicians'; D011451:Prostaglandin-Endoperoxide Synthases / Q000187:drug effects; D011720:Pyrazoles; D012189:Retrospective Studies; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use*; D013450:Sulfones; D014481:United States; D014493:United States Department of Veterans Affairs
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D007783:Lactones; D008565:Membrane Proteins; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D000068579:Celecoxib