title: Cost analysis of flavocoxid compared to naproxen for management of mild to moderate OA.
abstract: OBJECTIVE
  Flavocoxid is a medical food used for the clinical dietary management of osteoarthritis (OA). The acquisition cost of flavocoxid is higher than most traditional, generic NSAIDs. However, flavocoxid may have more favorable gastrointestinal (GI) toxicity resulting in lower overall costs. These costs have not been previously examined. This study provides a decision analytic model to assess the net costs of using flavocoxid for OA from a Medicare perspective.
  
  
  METHODS
  A decision model was developed to estimate the total costs associated with flavocoxid versus naproxen for the management of Medicare patients with mild to moderate OA. Probabilities were obtained from literature and expert opinion, and costs were obtained from Medicare. Sensitivity analyses were conducted by varying probabilities and costs within clinically relevant ranges.
  
  
  RESULTS
  The base case resulted in flavocoxid having lower total annual costs ($1482 per patient) compared to naproxen ($1592). Flavocoxid remained the lowest cost option when the cost inputs were varied by 25% (above and below the base case), and when the probability of GI events with flavocoxid were varied by 25%. However, when GI rates from the literature and implied relative risks from the expert panel were used, or if the cost of PPIs was $0, then naproxen was the less costly alternative, though saving less than the annual cost of flavocoxid. Key limitations were the limited outcomes in the model (only GI events), lack of consideration of adherence or combination therapy, and the reliance on expert opinion due to a lack of data for flavocoxid.
  
  
  CONCLUSIONS
  In patients over 65 years of age who suffer from mild to moderate OA, flavocoxid may result in lower overall costs, despite a higher acquisition cost. Managed care organizations should consider total health care costs in the decision to include flavocoxid as a covered benefit.
authors.affiliation: University of Illinois at Chicago, Department of Pharmacy Administration, Chicago, IL 60612, USA. Walton@uic.edu
authors.forename: Surrey M
authors.initials: SM
authors.lastname: Walton
authors.forename: Glen T
authors.initials: GT
authors.lastname: Schumock
authors.forename: David Andrew
authors.initials: DA
authors.lastname: McLain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002392:Catechin / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D004338:Drug Combinations; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D018803:Models, Economic; D009288:Naproxen / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012720:Severity of Illness Index
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; C544478:flavocoxid; D009288:Naproxen; D002392:Catechin