Prescribing COX-2s for patients new to cyclo-oxygenase inhibition therapy.
OBJECTIVE
To profile the pattern of cyclo-oxygenase 2 inhibitor (COX-2) use, including length of therapy, medical conditions treated, and gastrointestinal (GI) risk profile of users.


METHODS
Descriptive retrospective analysis of medical and prescription claims data from a large preferred provider organization in the Midwest.


METHODS
During an index period of January through May 31, 2000, patients new to COX-2 therapy were evaluated 365 days before and after their first prescription. Among the inclusion criteria, patients had to have no previous use of COX-2 therapy, be at least 18 years of age, and be continuously eligible during the entire study period.


RESULTS
Of the more than 300 000 members with at least 1 day of coverage in the index window, 1312 members met the inclusion criteria. The average age of COX-2 users was 49.5 years (SD = 11.4) and 60% were female. The number of days' supply of COX-2 agent obtained by members was highly skewed, with a mean of 116 days (SD = 119.5) and a median of 60 days. The medical conditions associated with COX-2 use included a variety of musculoskeletal conditions, the most common being low back pain (22%) and osteoarthritis (18%). Approximately 19% of members did not have a diagnosis associated with COX-2 use. Sixty-five percent of those new to COX-2 therapy did not have an indication of being at risk for GI events, and 68% had no indication for trying a lower-cost nonselective nonsteroidal anti-inflammatory drug (NSAID) prescription prior to beginning COX-2 therapy. Taken together, 45% did not have a GI risk factor or prior use of nonselective NSAID prescription therapy.


CONCLUSIONS
These findings suggest that opportunities exist to encourage the cost-effective prescribing of COX-2 therapy. Possible methods include implementation of step therapy, academic detailing, and physician education programs, among others.
Cox
Emily R
ER
Office of Research and Planning, Express Scripts, Inc., 13900 Riverport Drive, Maryland Heights, MO 63043, USA. ecox@express-scripts.com
Motheral
Brenda
B
Frisse
Mark
M
Behm
Andrew
A
Mager
Doug
D
D000328:Adult; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004194:Disease / Q000145:classification; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D007527:Isoenzymes / Q000187:drug effects*; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D015146:Midwestern United States; D011451:Prostaglandin-Endoperoxide Synthases / Q000187:drug effects*; D018570:Risk Assessment
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases