J Rheum Dis.  2017 Feb;24(1):27-34. 10.4078/jrd.2017.24.1.27.

Cost-effectiveness of Non-steroidal Anti-inflammatory Drugs Adjusting for Upper and Lower Gastrointestinal Toxicities in Rheumatoid Arthritis Patients

• Chung SJ
• Park HJ
• Park MC

• KMID: 2371675
• DOI: http://doi.org/10.4078/jrd.2017.24.1.27

Abstract

OBJECTIVE
This study was performed to assess the cost-effectiveness of cyclooxygenase-2 (COX2)-selective inhibitor, non-selective non-steroidal anti-inflammatory drugs (NSAIDs), and non-selective NSAID with proton pump inhibitors (PPIs) while considering upper and lower gastrointestinal (GI) safety in patients with rheumatoid arthritis (RA).
METHODS
A Markov model was used to estimate the costs and effectiveness. Estimates of therapeutic efficacy and upper/lower GI safety were based on results from large randomized controlled trials. The main outcome measure was cost effectiveness, based on the quality-adjusted life years (QALYs) gained. Safety parameters included clinical upper GI symptoms, uncomplicated ulcer, upper GI bleeding, upper GI perforation, clinical lower GI symptoms, lower GI bleeding, and lower GI perforation. Cost data were obtained from patients treated in a tertiary referral center in Korea.
RESULTS
The expected three year cost was 3,052,800 Korean won (KRW) for COX2-selective inhibitor, 3,170,800 KRW for nonselective NSAID, and 3,325,900 KRW for non-selective NSAID with PPI. QALYs were 2.87446, 2.85320, and 2.85815, respectively. The total cost for COX2-selective inhibitor use was lower than non-selective NSAID, but QALY was higher, indicating that the incremental cost effectiveness ratio of COX2-selective inhibitor is superior.
CONCLUSION
COX2-selective inhibitor has reasonable cost-effectiveness adjusted for upper and lower GI toxicity for patients with RA in Korea.

Keyword

Cost-effectiveness; Cox-2 selective inhibitor; Gastrointestinal toxicity; Non-steroidal anti-inflammatory drugs; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid*
Cost-Benefit Analysis
Cyclooxygenase 2
Hemorrhage
Humans
Korea
Outcome Assessment (Health Care)
Proton Pump Inhibitors
Quality-Adjusted Life Years
Tertiary Care Centers
Ulcer
Cyclooxygenase 2
Proton Pump Inhibitors

Figure

• 

  Figure 1. Part of a decision tree for cost-effectiveness of rheumatoid arthritis treatment. Three strategies are modeled by non-steroidal anti-inflammatory drug (naproxen or meloxicam), celecoxib, and NSAID with PPI. NSAID: non-steroidal antiinflammatory drug, PPI: proton-pump inhibitor, GI: gastrointestinal, UGI: upper gastrointestinal, LGI: lower gastrointestinal, EGD: esophagogastroduodenoscopy, MED: medication, CT: computed tomography.

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