PDG10 COST-EFFECTIVENESS OF CELECOXIB VERSUS IBUPROFEN AND NAPROXEN IN PATIENTS WITH OSTEOARTHRITIS IN UNITED ARAB EMIRATES AND SAUDI ARABIA BASED ON RESULTS FROM THE PRECISION TRIAL

Abstract

The cost-effectiveness of celecoxib (100mg twice daily) compared with ibuprofen (600-800mg three times daily) and naproxen (375-500mg twice daily) was evaluated from the perspectives of the United Arab Emirates (UAE) and the Kingdom of Saudi Arabia (KSA) using clinical data on osteoarthritis patients from the PRECISION trial. Discrete-state Markov model with monthly cycles and 30-month horizon was constructed to assess long-term total cost (drug plus toxicities) and quality of life. Incremental costs/QALY gained from reduced incidence of three toxicities domains examined in PRECISION were modelled: renal, serious gastrointestinal, and major adverse cardiovascular (MACE) events. Health utilities and excess mortality parameters were sourced from literature. UAE costs for managing toxicities were obtained from Dubai Billing Claims (2018) and, for KSA, reduced by 20%. Drug costs were sourced from UAE Ministry of Health and Prevention and KSA Food and Drug Authority. The willingness-to-pay threshold used was 1 GDP per capita (∼$40,000 for UAE and ∼$20,000 for KSA). Total cost and QALYs per patient were calculated separately for UAE (celecoxib: $812.88, 1.339; ibuprofen: $775.26, 1.335; and naproxen: $731.17, 1.337) and KSA (celecoxib: $584.07, 1.335; ibuprofen: $573.23, 1.332; and naproxen: $669.40, 1.333). In both countries, celecoxib had the lowest toxicity cost and greatest QALYs gained. In UAE, the ICER for celecoxib was $11,502/QALY versus ibuprofen and $39,799/QALY versus naproxen. In KSA, the ICER for celecoxib was $3,630/QALY versus ibuprofen and dominant versus naproxen. Probabilistic sensitivity analyses in UAE demonstrated celecoxib is cost-effective 76% of the time versus ibuprofen and 52% versus naproxen, while in KSA it is respectively 75% and 90%. In UAE, celecoxib is a long-term cost-effective treatment for osteoarthritis patients when compared with ibuprofen. In KSA, celecoxib is a long-term cost-effective option for both ibuprofen and naproxen. These findings inform cost-effective osteoarthritis pain management in the Gulf region.