J Korean Rheum Assoc.  2002 Dec;9(4):278-291.

Korean Cost-Effectiveness of Low Dose Corticosteroids versus Nonsteroidal Anti-Inflammatory Drugs in the Long-Term Treatment of Rheumatoid Arthritis

• Oh SI
• Yun HR
• Bae SC

Abstract

OBJECTIVE
Low dose corticosteroids (steroid) (METHODS
Markov (state-transition) models were used to simulate a cohort of RA patients with 50 years, taking disease modifying anti-rheumatic drugs and either steroid or NSAIDs. The regimens were assumed to be equally effective for the control of RA. Data on incidence and consequences of AEs from steroid and from NSAIDs were taken from the literature. Direct medical costs were measured in 2000 Korean Won; health effects expressed as quality-adjusted life years (QALYs). Sensitivity analyses were performed including best-case scenarios (0.5 X AE rate) and worst-case scenarios (1.5 X AE rate).
RESULTS
In the base-case analysis, the incremental C/E ratio between steroid and NSAIDs was 1,423 X 103 Won/QALY (1,197 US$/QALY). The sensitivity analyses of AE rate, using best-case and worst-case scenarios showed that the result was sensitive to each combination of AE rate. In contrast, the sensitivity analyses of costs, age and utilities were robust. Using misoprostol or omeprazole prophylaxis with NSAIDs would make steroid dominant. Compared to NSAIDs with cyclooxygenase 2 (COX-2) specific inhibitor, the incremental C/E ratio between COX-2 specific inhibitor and NSAIDs was 139,322 X 10(3) Won/ QALY (117,274 US$/QALY).
CONCLUSION
Steroid are more cost-effective than NSAIDs in the long-term treatment of RA in Korea.

Keyword

Cost-effectiveness; Steroid; Nonsteroidal anti-inflammatory drugs; Rheumatoid arthritis

MeSH Terms

Adrenal Cortex Hormones*
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Arthritis, Rheumatoid*
Cohort Studies
Cyclooxygenase 2
Delivery of Health Care
Humans
Incidence
Korea
Misoprostol
Omeprazole
Quality-Adjusted Life Years
Rheum
Adrenal Cortex Hormones
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Cyclooxygenase 2
Misoprostol
Omeprazole