Abstract
Background: Cyclooxygenase-2 inhibitors such as celecoxib are as effective as non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) in the treatment of osteoarthritis (OA), have fewer gastrointestinal side effects, but are more expensive. Objective: To evaluate the incremental cost-effectiveness ratio (ICER) of celecoxib versus ns-NSAIDs, with/without proton-pump inhibitor (PPI) co-therapy, for treating OA in Algeria. Methods: The National Institute for Health and Clinical Excellence (NICE) health economic model from UK, updated with relative risks of adverse events using CONDOR trial data, was adapted for costeffectiveness analysis in OA patients aged ≥65 years. Patients could initiate treatment with celecoxib or ns-NSAIDs with/without omeprazole. Conditional probabilities were obtained from published clinical trials; effectiveness measure was quality-adjusted life years (QALYs) gained/patient. The analysis was conducted from a healthcare payer’s perspective. The average daily treatment costs and frequencies of resource use for adverse events were based on data collected in August 2011 from a private clinic located in Cheraga, Algiers, Algeria. Probabilistic sensitivity analysis (PSA) was performed to construct cost-effectiveness acceptability curves (CEACs). Results: QALYs gained/patient over a 6-month horizon were higher with celecoxib (0.368) and celecoxib+PPI (0.40) versus comparators. The lowest expected cost/patient was associated with ibuprofen (US$134.76 versus US$175.67 with celecoxib+PPI, and US$177.57 with celecoxib). Celecoxib+PPI was the most cost-effective drug treatment, with an ICER of US$584.43, versus ibuprofen. Treatment with celecoxib alone showed an ICER of US$1,530.56 versus diclofenac+PPI. These ICERs are <1 gross domestic product per capita in Algeria (US$7,500). Over 1-year, 3-year and 5-year horizons, celecoxib with/without PPI co-therapy showed higher QALYs/patient versus comparators, and decreasing ICERs. The ICER of celecoxib+PPI was lower than that of comparators over all time horizons. These findings were confirmed with CEACs generated via PSA. Conclusion: Using data from a single private clinic in Cheraga, Algiers, Algeria, and after considering new adverse event risks, we showed that celecoxib with/without PPI co therapy is more cost-effective than ns-NSAID+PPI for treating OA patients aged ≥65 years. Celecoxib+PPI remains dominant over a 5-year horizon, making it the most cost-effective treatment option for medium- and long-term use.
Highlights
Osteoarthritis (OA) is a degenerative condition of the cartilage characterized by joint pain leading to functional limitations and, disability and decreased quality of life.[1]
Using data from a single private clinic in Cheraga, Algiers, Algeria, and after considering new adverse event risks, we showed that celecoxib with/without pump inhibitor (PPI) co-therapy is more cost-effective than ns-non-steroidal anti-inflammatory drugs (NSAIDs)+PPI for treating OA patients aged ≥65 years
Ie, treatment over a period of 6 months, showed that the estimated effectiveness in terms of quality-adjusted life years (QALYs) gained per patient was higher with celecoxib (0.368 QALYs/patient) and celecoxib plus PPI (0.40 QALYs/patient) versus all comparators for treating OA patients aged ≥65 years
Summary
Osteoarthritis (OA) is a degenerative condition of the cartilage characterized by joint pain leading to functional limitations and, disability and decreased quality of life.[1] The disease predominantly affects weight-bearing and stressed joints such as the knee, hip, and small joints of the hands.[1,2] The main risk factors for OA include age >40 years, female gender, positive family history, occupation and obesity.[3] the exact prevalence of OA is unknown, it is expected that incidence and prevalence will increase as life expectancy improves worldwide. Pain relief with pharmacological therapy is an important component of managing OA. While paracetamol and topical non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of treatment for OA, it is recommended to use oral NSAIDs including cyclooxygenase 2 (COX-2) inhibitors or opioid drugs, if firstline therapy fails to provide pain relief.[1]. Cyclooxygenase-2 inhibitors such as celecoxib are as effective as non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) in the treatment of osteoarthritis (OA), have fewer gastrointestinal side effects, but are more expensive
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