Abstract
BackgroundPrevious 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.MethodsWe 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.ResultsOur 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.ConclusionOur 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.
Highlights
Introduction to the epidemiology of dyspepsiaScand J Gastroenterol Suppl 1985, 109:29-33.11
Incremental treatment costs and benefits of $4,055 and 0.1304 quality-adjusted life-year (QALY) resulted in a base-case celecoxib versus nsNSAID incremental cost-effectiveness ratio (ICER) of $31,097 per QALY, which falls within the range normally considered to be cost-effective (Table 4)
Sensitivity testing Uncertainty One-way sensitivity analysis results for clinical and economic variables showed that the ICER rose above $60,000 per QALY for only 2 of the variables when ranged over the values in Tables 1, 2, or 3, the nsNSAID peptic ulcer and POB probabilities [65]
Summary
Introduction to the epidemiology of dyspepsiaScand J Gastroenterol Suppl 1985, 109:29-33.11. Bae SC, Corzillius M, Kuntz KM, Liang MH: Cost-effectiveness of low dose corticosteroids versus non-steroidal anti-inflammatory drugs and COX-2 specific inhibitors in the long-term treatment of rheumatoid arthritis. Previous evaluations of the cost-effectiveness of the cyclooxygenase-2 selective inhibitor celecoxib (Celebrex, Pfizer Inc, USA) have produced conflicting results. 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. The objective of our study was to evaluate the cost-effectiveness of the long-term use of celecoxib compared with nsNSAIDs in a population of 60-year-old OA patients with average risks of upper gastrointestinal (UGI) complications who require chronic daily NSAID therapy. The distinctive features of our study are its evaluations of a comprehensive indicator of serious cardiovascular (CV) thromboembolic risk, alternate treatment regimens after UGI adverse events, and differences in the lengths of the analytic horizon
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