Authors' objectives:

The purpose of this assessment is to evaluate the long-term cost-effectiveness of the COX2 NSAIDs celecoxib, in comparison to diclofenac and ibuprofen, and rofecoxib in comparison to naproxen, in patients with OA and RA who are not on low-dose aspirin for the prevention of cardiovascular (CV) disease. Analyses are performed for patients at average risk of upper gastrointestinal (UGI) events, and for higher risk patients with a history of a UGI event that is either (a) a clinical UGI event (a symptomatic ulcer), as shown by endoscopy, or (b) a complicated UGI event (a GI perforation, obstruction or major bleeding).

Authors' results and conclusions: For average-risk patients, base case results were more than $200,000 per quality-adjusted life-year (QALY) gained for rofecoxib vs naproxen and for celecoxib vs ibuprofen. Diclofenac was more effective and less costly than celecoxib in average-risk patients. Cost-effectiveness results for average-risk patients did not fall below $86,000 per QALY gained for either COX-2 NSAID in any sensitivity analysis preformed. For high risk patients, the base case results showed the COX-2 NSAIDs to be more effective and less costly for rofecoxib vs naproxen + PPI and for celecoxib vs ibuprofen + PPI. Diclofenac had a cost per QALY gained of $255,000 compared to celecoxib in high risk patients. In sensitivity analysis, results fall below $50,000 per QALY gained when high risk patients are treated with regular NSAIDs + a low priced PPI (< $1.90 per day) compared to COX2 NSAIDs, with the threshold PPI price dependent on the particular treatments being compared. Analysis by age group showed that the results for rofecoxib and celecoxib fall below $50,000 per QALY gained in patients without additional risk factors over age 76 and 81, respectively.

Authors' recommendations: The findings are based on the clinical outcomes (including upper gastrointestinal events and myocardial infarctions) in the CLASS and VIGOR trials and pertain only to patients with OA and RA who do not require low-dose aspirin therapy. In the analysis, rofecoxib and celecoxib: (i) are not cost-effective treatments in patients at average risk of upper gastrointestinal events (symptomatic ulcers or complicated UGI events) or in a population with a typical mix of average risk and high risk patients; (ii) are cost-effective treatments for patients who are considered at high risk for gastrointestinal events by having a history of upper gastrointestinal events; (iii) become less cost-effective in high risk patients as the rate of co-prescription of PPIs increase, and may lose their cost-effective advantage altogether if the price of PPIs was to decrease, with the threshold PPI price dependent on the particular treatments being compared; and (iv) become cost-effective treatments for patients without additional risk factors over the age of 76 for rofecoxib and 81 for celecoxib. It is noted that rofecoxib is currently not approved in Canada for the treatment of RA. Uncertainty remains about the correct method for deriving utilities for short-term health states.

Authors' methods: Cost study

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment (CCOHTA)