title: Selective COX-2 inhibitors: a health economic perspective.
abstract: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is common in patients with osteoarthritis and rheumatoid arthritis. However, due to gastrointestinal side effects, the health-related and economic burden related to these drugs is considerable. Therefore, substituting or supplementing conventional NSAIDs with safer drugs that have a better risk profile not only may avoid serious complications but may also be an efficient allocation of scarce resources. Because of their better gastrointestinal risk profile, the newly developed selective COX-2 inhibitors celecoxib and rofecoxib are discussed as cost-effective alternatives to common NSAIDs. This paper provides an overview of health economic evaluations, conducted during the last few years, that investigate the economic consequences of switching patients from traditional NSAIDs to selective COX-2 inhibitors. This review of the health economic literature shows that results of the health economic assessments of COX-2 inhibitors are highly contradictory. The main divergence between studies occurs in estimated economic consequences of adopting COX-2 inhibitors in patients at low or average risk for developing gastrointestinal side effects. The economic consequences of the introduction of COX-2 inhibitors as well as the asynchronous development of scientific acceptance of the benefit of the new drugs and their actual diffusion and spread are discussed taking a broader, healthcare-system perspective.
authors.affiliation: Lehrstuhl für Gesundheitspolitik und -management, Fakultät der Medizin, Universität Witten/Herdecke, Alfred-Herrhausen-Strasse 50, D-58448 Witten, Germany. dlb@h-ero.de
authors.forename: David L B
authors.initials: DL
authors.lastname: Schwappach
authors.forename: Christian M
authors.initials: CM
authors.lastname: Koeck
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D017046:Cost Savings / Q000706:statistics & numerical data; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors*; D008565:Membrane Proteins; D009313:National Health Programs / Q000191:economics*; D010003:Osteoarthritis / Q000188:drug therapy / Q000191:economics*; D010437:Peptic Ulcer / Q000139:chemically induced / Q000191:economics; D011451:Prostaglandin-Endoperoxide Synthases
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases