Gastrointestinal health care resource utilization with chronic use of COX-2-specific inhibitors versus traditional NSAIDs

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 125; no. 2; pp. 389 - 395
• Main Authors: Laine, Loren, Wogen, Jenifer, Yu, Holly
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-08-2003; Elsevier
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Cohort Studies; Cost-Benefit Analysis; Cyclooxygenase 2; Cyclooxygenase 2 Inhibitors; Cyclooxygenase Inhibitors - adverse effects; Drug toxicity and drugs side effects treatment; Female; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - economics; Health Resources - statistics & numerical data; Humans; Isoenzymes - antagonists & inhibitors; Isoenzymes - physiology; Longitudinal Studies; Male; Medical sciences; Membrane Proteins; Middle Aged; Pharmacology. Drug treatments; Prostaglandin-Endoperoxide Synthases - physiology; Retrospective Studies; Toxicity: digestive system; PPI; GI; coxibs; COX-2; Consumption; Human; Prostaglandin-endoperoxide synthase; Enzyme; Enzyme inhibitor; Pharmacology; Health service; Gastrointestinal; Incidence; Non steroidal antiinflammatory agent; Chronic; Digestive diseases; Intestinal disease; Complication; Oxidoreductases; Biological effect; Public health; Comparative study; Gastric disease
• ISSN: 0016-5085; 1528-0012
• DOI: 10.1016/S0016-5085(03)00900-4

Cyclooxygenase 2 (COX-2)-specific inhibitors (coxibs) decrease gastrointestinal (GI) events in controlled trials, but results in clinical practice are unknown. We assessed GI-related resource use and costs in patients switching from chronic nonsteroidal anti-inflammatory drug (NSAID) therapy to chronic coxib therapy and in patients starting chronic NSAID therapy vs. chronic coxib therapy in a U.S. administrative claims database of >8 million lives.
“Switchers” (n = 2246) were assessed in the 12-month periods before and after switching from chronic NSAID therapy to coxib therapy. “New NSAID” (n = 25,989) and “new coxib” (n = 2125) groups were assessed for the 12-month periods before and after the initial prescription. Proportions of patients with GI resource use (odds ratio [OR] adjusted for relevant covariates) and costs were compared.
The adjusted OR for any GI resource use (coxib vs. NSAID period) among switchers was 0.86 (0.74–0.99). The decrease was due to less GI cotherapy (OR = 0.82 [0.69–0.97]). Costs were not significantly lower after switching to coxibs (mean difference, −$19; 95% CI: −$139, $55), although after adding NSAID/coxib costs, the total cost in the coxib period was significantly higher (mean increase, $377; $271, $488). Adjusted OR for GI resource use for new-coxib vs. new-NSAID was 1.04 (0.92–1.16), but GI costs were significantly lower in new-NSAID patients.
Patients switching from chronic NSAID therapy to chronic coxib therapy had a slight decrease in the proportion using GI-related resources but not in GI costs. When NSAID/coxib drug costs were included, costs were significantly less with NSAIDs than with coxibs. The potential GI-related cost savings suggested in coxib clinical trials may not be fully realized in “real-world” settings.