Minimizing complications from nonsteroidal antiinflammatory drugs: Cost‐effectiveness of competing strategies in varying risk groups

• Published in: Arthritis and rheumatism Vol. 53; no. 2; pp. 185 - 197
• Main Authors: Spiegel, Brennan M. R., Chiou, Chiun‐Fang, Ofman, Joshua J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15-04-2005; Lippincott Williams and Wilkins
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - economics; Arthritis - complications; Arthritis - drug therapy; Arthritis - economics; Aspirin - therapeutic use; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Celecoxib; Cost-Benefit Analysis; Cost‐effectiveness; Cox‐2 inhibitors; Drug Therapy, Combination; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - economics; Gastrointestinal Diseases - pathology; Humans; Lactones - adverse effects; Lactones - economics; Lansoprazole; Medical sciences; Naproxen - adverse effects; Naproxen - economics; Nonsteroidal antiinflammatory drugs; Omeprazole - adverse effects; Omeprazole - analogs & derivatives; Omeprazole - economics; Pharmacology. Drug treatments; Proton Pump Inhibitors; Pyrazoles - adverse effects; Pyrazoles - economics; Rheumatology - economics; Sulfonamides - adverse effects; Sulfonamides - economics; Sulfones - adverse effects; Sulfones - economics; Health economy; Cos-2 inhibitors; Antiinflammatory agent; Risk factor; Complication; Risk; Proton pump inhibitors; Cost-effectiveness; Public health; Cost efficiency analysis; Proton pump inhibitor; Nonsteroidal antiinflammatory drugs
• ISSN: 0004-3591; 0893-7524; 1529-0131; 1529-0123
• DOI: 10.1002/art.21065

Objective
To appraise the cost‐effectiveness of competing therapeutic strategies in patient cohorts eligible for aspirin prophylaxis with varying degrees of gastrointestinal (GI) and cardiovascular risk.
Methods
Cost‐effectiveness and cost‐utility analyses were performed to evaluate 3 competing strategies for the management of chronic arthritis: 1) a generic nonselective nonsteroidal antiinflammatory drug (NSAIDNS) alone; 2) NSAIDNS plus a proton pump inhibitor (PPI); and 3) a cyclooxygenase 2‐selective inhibitor (coxib) alone. Cost estimates were from a third‐party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality‐adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use.
Results
In average‐risk patients, the NSAIDNS + PPI strategy costs an incremental $45,350 per additional ulcer complication avoided and $309,666 per QALY gained compared with the NSAIDNS strategy. The coxib strategy was less effective and more expensive than the NSAIDNS + PPI strategy. Sensitivity analysis revealed that the NSAIDNS + PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with ≥1 risk factor for a GI complication).
Conclusion
Generic nonselective NSAIDs are most cost‐effective in patients at low risk for an adverse event. However, the addition of a PPI to a nonselective NSAID may be the preferred strategy in patients taking aspirin or otherwise at high risk for a GI or cardiovascular adverse event.