Costs and effects of various analgesic treatments for patients with rheumatoid arthritis and osteoarthritis in the Netherlands.
OBJECTIVE
To assess the balance between costs and upper gastrointestinal (GI) side effects of treatment with celecoxib, nonsteroidal antiinflammatory drugs (NSAIDs) alone, NSAID plus misoprostol, NSAID plus histamine-2 receptor antagonist (H(2)RA), NSAID plus proton pump inhibitor (PPI), and Arthrotec in The Netherlands.


METHODS
A model was used to convene data from various sources on the probability of GI side effects and resource use. The probabilities of GI side effects for celecoxib and NSAIDs alone were derived from trial data. Calculations were based on 6 months of treatment, and were from a societal perspective. Distinction was made between low-, medium-, and high-risk patients. An extensive probabilistic sensitivity analysis was performed to address uncertainty.


RESULTS
Assuming an average patient, the total costs per 6 months of therapy were: celecoxib 255 Euro, NSAIDs alone 166 Euro, NSAID plus misoprostol 285 Euro, NSAID plus H(2)RA 284 Euro, NSAID plus PPI 243 Euro, and Arthrotec 187 Euro. Treatment with celecoxib was associated with the lowest number of GI side effects and related deaths. Incremental costs per life-year saved for Arthrotec compared to NSAIDs alone were 5676 Euro for all patients and 526 Euro for medium-to-high-risk patients, whereas for high-risk patients, Arthrotec dominated NSAID alone. For celecoxib compared to Arthrotec, the incremental cost-effectiveness ratios (ICERs) were 56,667 Euro, 33,684 Euro, and 15,429 Euro, respectively.


CONCLUSIONS
Assuming a limit of 20,000 Euro per life-year gained, from an economic point of view, Arthrotec is the preferred treatment when all patients or medium-to-high-risk patients are considered. In high-risk patients, celecoxib is the preferred treatment strategy.
Al
Maiwenn J
MJ
Institute for Medical Technology Assessment, Erasmus MC, Rotterdam, The Netherlands. m.al@erasmusmc.nl
Maniadakis
Nikos
N
Grijseels
Els W M
EW
Janssen
Matthijs
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D000068579:Celecoxib; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004008:Diclofenac / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016595:Misoprostol / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D009426:Netherlands; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics*; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011720:Pyrazoles / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D013449:Sulfonamides / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; C078133:Arthrotec; D004338:Drug Combinations; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D016595:Misoprostol; D004008:Diclofenac; D000068579:Celecoxib