An economic model of long-term use of celecoxib in patients with osteoarthritis.
BACKGROUND
Previous evaluations of the cost-effectiveness of the cyclooxygenase-2 selective inhibitor celecoxib (Celebrex, Pfizer Inc, USA) have produced conflicting results. The recent controversy over the cardiovascular (CV) risks of rofecoxib and other coxibs has renewed interest in the economic profile of celecoxib, the only coxib now available in the United States. The objective of our study was to evaluate the long-term cost-effectiveness of celecoxib compared with nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs) in a population of 60-year-old osteoarthritis (OA) patients with average risks of upper gastrointestinal (UGI) complications who require chronic daily NSAID therapy.


METHODS
We used decision analysis based on data from the literature to evaluate cost-effectiveness from a modified societal perspective over patients' lifetimes, with outcomes expressed as incremental costs per quality-adjusted life-year (QALY) gained. Sensitivity tests were performed to evaluate the impacts of advancing age, CV thromboembolic event risk, different analytic horizons and alternate treatment strategies after UGI adverse events.


RESULTS
Our main findings were: 1) the base model incremental cost-effectiveness ratio (ICER) for celecoxib versus nsNSAIDs was $31,097 per QALY; 2) the ICER per QALY was $19,309 for a model in which UGI ulcer and ulcer complication event risks increased with advancing age; 3) the ICER per QALY was $17,120 in sensitivity analyses combining serious CV thromboembolic event (myocardial infarction, stroke, CV death) risks with base model assumptions.


CONCLUSIONS
Our model suggests that chronic celecoxib is cost-effective versus nsNSAIDs in a population of 60-year-old OA patients with average risks of UGI events.
Loyd
Michael
M
Michael Loyd & Associates Ltd, Winnipeg, Manitoba, Canada. mloydassoc@shaw.ca <mloydassoc@shaw.ca>
Rublee
Dale
D
Jacobs
Philip
P
D000367:Age Factors; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use; D000068579:Celecoxib; D003362:Cost-Benefit Analysis; D004008:Diclofenac / Q000191:economics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D020714:Maximum Tolerated Dose; D008875:Middle Aged; D018803:Models, Economic; D009288:Naproxen / Q000191:economics / Q000627:therapeutic use; D010003:Osteoarthritis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D011336:Probability; D011720:Pyrazoles / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013449:Sulfonamides / Q000191:economics* / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D004008:Diclofenac; D009288:Naproxen; D000068579:Celecoxib