title: Impact of Celecoxib restrictions in medicare beneficiaries with arthritis.
abstract: OBJECTIVE
  To compare the incidence of serious gastrointestinal (GI) complications and associated medical costs in a population with either osteoarthritis (OA) or rheumatoid arthritis (RA) enrolled in Medicare plans with celecoxib formulary restrictions versus plans without such restrictions.
  
  
  METHODS
  This study was a retrospective cohort analysis of Medicare members in plans with and without celecoxib restrictions. Members diagnosed with OA or RA were identified and followed for 1 year.
  
  
  RESULTS
  The restricted group had higher levels of nonselective nonsteroidal anti-inflammatory drug use (51% vs 40%, p <.001), and celecoxib use was double in the unrestricted group (16% vs 8%, p <.001). The incidence of a serious GI complication was slightly higher in the restricted group (5.4% vs 4.6%, P <.001). The adjusted mean serious GI complication-related cost for the restricted group was more than 15 times higher than that for the nonrestricted group ($1559 [95% confidence interval (CI) $1341-$1811] vs $101 [95% CI $87-$117]), adjusted mean arthritis-related medical costs were $5733 per year (95% CI $5097-$6448) for the restricted group and $3170 (95% CI $2816-$3569) for the unrestricted group.
  
  
  CONCLUSIONS
  The restricted group had significantly less use of celecoxib, indicating that restriction was effective at reducing celecoxib utilization. Although limitations exist when comparing populations from different health plans, and the underlying causes of serious GI complications are multifactorial, the restricted group had a higher incidence of serious GI complications and higher costs related to serious GI complications and arthritis.
authors.affiliation: Competitive Health Analytics, Louisville, KY 40202, USA. alouder@humana.com
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Louder
authors.forename: Ashley V
authors.initials: AV
authors.lastname: Joshi
authors.forename: Amy T
authors.initials: AT
authors.lastname: Ball
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.forename: Michael C
authors.initials: MC
authors.lastname: Deminski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000191:economics; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D000068579:Celecoxib; D015331:Cohort Studies; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000150:complications* / Q000188:drug therapy; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D014481:United States
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib