title: Efficiency of naproxen/esomeprazole in association for osteoarthrosis treatment in Spain.
abstract: OBJECTIVE
  To assess, from the perspective of the National Healthcare System, the efficiency of a fixed-dose combination of naproxen and esomeprazole (naproxen/esomeprazole) in the treatment of osteoarthritis (OA) compared to other NSAID, alone or in combination with a proton pump inhibitor (PPI).
  
  
  METHODS
  A Markov model was used; it included different health states defined by gastrointestinal (GI) events: dyspepsia, symptomatic or complicated ulcer; or cardiovascular (CV) events: myocardial infarction, stroke or heart failure. The model is similar to the one used by NICE in its NSAID evaluation of OA published in 2008. The total costs (€, 2012), including drug and event-related costs, and the health outcomes expressed in quality-adjusted life years (QALY) were estimated in patients with increased GI risk, aged 65 or over, for a 1-year time horizon and a 6-month treatment with celecoxib (200mg/day), celecoxib+PPI, diclofenac (150mg/day)+PPI, etoricoxib (60mg/day), etoricoxib+PPI, ibuprofen (1,800mg/day)+PPI, naproxen (1,000mg/day)+PPI or naproxen/esomeprazole (naproxen 1,000mg/esomeprazole 40mg/day). The selected PPI was omeprazole (20mg/day).
  
  
  RESULTS
  Naproxen/esomeprazole was a dominant strategy (more effective and less costly) compared to celecoxib, etoricoxib and diclofenac+PPI. Celecoxib+PPI and etoricoxib+PPI were more effective. Considering a cost-effectiveness threshold of €30,000 per additional QALY, naproxen/esomeprazole was cost-effective compared to ibuprofen+PPI and naproxen+PPI with incremental cost-effectiveness ratios (ICER) of €15,154 and €5,202 per additional QALY, respectively.
  
  
  CONCLUSIONS
  A fixed-dose combination of naproxen and esomeprazole is a cost-effective, and even dominant, alternative compared to other options in OA patients with increased GI risk.
authors.affiliation: Health Economics & Outcomes Research, AstraZeneca Farmacéutica Spain, Madrid, España.
authors.forename: Margarita
authors.initials: M
authors.lastname: Capel
authors.affiliation: Servicio de Reumatología, Hospital General Universitario de Guadalajara, Guadalajara, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Tornero
authors.affiliation: Servicio de Cardiología, Hospital Ramón y Cajal, Madrid, España.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Madrid, España. Electronic address: ioyaguez@porib.com.
authors.forename: Itziar
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: Pharmacoeconomics and Outcomes Research Iberia, Madrid, España.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Casado
authors.affiliation: Health Economics & Outcomes Research, AstraZeneca Farmacéutica Spain, Madrid, España.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Sánchez-Covisa
authors.affiliation: Servicio de Aparato Digestivo, Hospital Clínico, CIBERehd, IIS Aragón, Universidad de Zaragoza, Zaragoza, España.
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D064098:Esomeprazole / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D009288:Naproxen / Q000191:economics* / Q000627:therapeutic use*; D010003:Osteoarthritis / Q000188:drug therapy* / Q000191:economics*; D054328:Proton Pump Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D013030:Spain
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D054328:Proton Pump Inhibitors; D009288:Naproxen; D064098:Esomeprazole
keywords: Antiinflamatorios no esteroideos; Artrosis; Cost-utility; Coste-utilidad; Nonsteroidal anti-inflammatory drugs; Osteoarthrosis