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The Cost-Effectiveness of Cyclooxygenase-2 Inhibitors for Treating Chronic Arthritis
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What is the problem and what is known about it so far?
Arthritis causes pain, stiffness, and swelling in the joints. There are many types of arthritis, but the most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis results from wear and tear on the joints. Rheumatoid arthritis is a condition of the immune system that damages the joints. Pain is a problem in both of these types of arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are common treatments for arthritis pain. Unfortunately, NSAIDs can irritate the stomach and cause ulcers, which are open sores in the stomach lining. In addition to being painful, ulcers can bleed, sometimes severely. Cyclooxygenase-2 (COX-2) inhibitors are other drugs that treat arthritis pain. Examples of COX-2 inhibitors are celecoxib and rofecoxib. COX-2 inhibitors are as effective as NSAIDs but irritate the stomach less. COX-2 inhibitors are much more expensive than NSAIDs. Since most people receiving NSAIDs never develop ulcers, it is unclear whether the increased costs of COX-2 inhibitors are worth the potential benefits.
Why did the researchers do this particular study?
To see whether the benefits of COX-2 inhibitors for treating arthritis is worth the extra cost compared with NSAIDs.
Who was studied?
Rather than studying actual patients, the researchers used computers to simulate what would happen to a “virtual” group of patients with osteoarthritis or rheumatoid arthritis who took either an NSAID or a COX-2 inhibitor to treat osteoarthritis or rheumatoid arthritis. They assumed that none of these patients also took aspirin, another drug that irritates the stomach.
How was the study done?
The researchers used published information to estimate what might happen (and how much it would cost) if patients took an NSAID or a COX-2 inhibitor. They put these estimates into a computer model and calculated how much COX-2 inhibitors cost for each year of life saved by avoiding bleeding ulcers compared with NSAIDs. The calculations accounted for both quality and length of life.
What did the researchers find?
The researchers estimated that using COX-2 inhibitors instead of NSAIDs to treat chronic arthritis cost $275,809 per quality-adjusted year of life saved. This amount is substantially more than Americans are typically willing to pay for other health care treatments. The cost-effectiveness of COX-2 inhibitors was in an acceptable range only for the group of patients who had a history of a bleeding ulcer before starting treatment. To be cost-effective for patients with arthritis in general, regardless of whether patients had a previous ulcer, COX-2 inhibitors would need to drop to one tenth of their current average price.
What were the limitations of the study?
This study was a computer simulation, so we cannot be sure what the results would be with actual patients.
What are the implications of the study?
Unless the price of COX-2 inhibitors drops substantially, their benefits are worth the extra costs compared with naproxen only for patients who have had a previous bleeding ulcer.
Article and Author Information
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The summary below is from the full report titled “The Cost-Effectiveness of Cyclooxygenase-2 Selective Inhibitors in the Management of Chronic Arthritis.” It is in the 20 May 2003 issue of Annals of Internal Medicine (volume 138, pages 795-806). The authors are B.M.R. Spiegel, L. Targownik, G.S. Dulai, and I.M. Gralnek.
- Copyright ©2004 by the American College of Physicians
