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Efficiency of naproxen/esomeprazole in association for osteoarthrosis treatment in Spain. ACTA ACUST UNITED AC 2013; 10:210-7. [PMID: 24380809 DOI: 10.1016/j.reuma.2013.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/21/2013] [Accepted: 11/20/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess, from the perspective of the National Healthcare System, the efficiency of a fixed-dose combination of naproxen and esomeprazole (naproxen/esomeprazole) in the treatment of osteoarthritis (OA) compared to other NSAID, alone or in combination with a proton pump inhibitor (PPI). METHODS A Markov model was used; it included different health states defined by gastrointestinal (GI) events: dyspepsia, symptomatic or complicated ulcer; or cardiovascular (CV) events: myocardial infarction, stroke or heart failure. The model is similar to the one used by NICE in its NSAID evaluation of OA published in 2008. The total costs (€, 2012), including drug and event-related costs, and the health outcomes expressed in quality-adjusted life years (QALY) were estimated in patients with increased GI risk, aged 65 or over, for a 1-year time horizon and a 6-month treatment with celecoxib (200mg/day), celecoxib+PPI, diclofenac (150mg/day)+PPI, etoricoxib (60mg/day), etoricoxib+PPI, ibuprofen (1,800mg/day)+PPI, naproxen (1,000mg/day)+PPI or naproxen/esomeprazole (naproxen 1,000mg/esomeprazole 40mg/day). The selected PPI was omeprazole (20mg/day). RESULTS Naproxen/esomeprazole was a dominant strategy (more effective and less costly) compared to celecoxib, etoricoxib and diclofenac+PPI. Celecoxib+PPI and etoricoxib+PPI were more effective. Considering a cost-effectiveness threshold of €30,000 per additional QALY, naproxen/esomeprazole was cost-effective compared to ibuprofen+PPI and naproxen+PPI with incremental cost-effectiveness ratios (ICER) of €15,154 and €5,202 per additional QALY, respectively. CONCLUSIONS A fixed-dose combination of naproxen and esomeprazole is a cost-effective, and even dominant, alternative compared to other options in OA patients with increased GI risk.
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Analisi di costo della terapia con celecoxib vs FANS tradizionali nell’artrosi in Italia. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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3
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Consumo di risorse e costi per la diagnosi e la cura degli eventi avversi gastrointestinali dovuti all’uso dei FANS. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/bf03320580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gyllensten H, Jönsson AK, Rehnberg C, Carlsten A. How are the costs of drug-related morbidity measured?: a systematic literature review. Drug Saf 2012; 35:207-19. [PMID: 22242773 DOI: 10.2165/11597090-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Drug-related morbidity has been associated with increased healthcare costs and has been suggested as one of the leading causes of death. Previous reviews have identified heterogeneity in research methods in studies measuring the cost of drug-related morbidity. To date, no attempt has been made to analyse different methods and cost sources used when estimating the costs of drug-related morbidity. OBJECTIVE The aim of this review was to evaluate and compare methods and data sources in cost estimates of drug-related morbidity. METHODS A literature search was conducted in three electronic databases (CINAHL, EMBASE and MEDLINE) to identify peer-reviewed articles written in English and published between January 1990 and November 2011. Articles were included if estimating the direct or indirect costs of drug-related morbidity based on clinical data from general patient groups. The general patient groups were defined as patients visiting, being admitted to, treated at or discharged from a general hospital, excluding studies from nursing homes or specialized hospitals. Study information was collected using a standardized data collection sheet. Studies were categorized according to the type of costs included in the cost analysis. Thereafter, the cost analyses of included studies were reviewed regarding viewpoint, costing methods and adjustments for timing of costs. RESULTS In total, 9569 articles were identified, of which 25 publications were included in this review, and four additional articles were identified from reference or citation lists of publications already included. Eighteen studies measured either the total or attributable costs of drug-related morbidity, while seven studies estimated the increased costs using matched controls or regression analyses. Six studies measured costs from a payer perspective, while the other 23 measured costs to the hospital. One study included costs resulting after discharge, and discounted future costs, while the remaining 28 studies measured costs during the initial admission only and involved no adjustment for timing of costs. CONCLUSIONS The data sources and costs measured in the included studies varied considerably in terms of perspectives and use of data sources. Even though there is a trend towards more studies estimating costs from the payer perspective, the identified studies still focused on costs resulting from patients attending hospital, therefore underestimating the cost of drug-related morbidity. There is thus a need for more research on the costs of drug-related morbidity to providers other than hospitals, and costs occurring outside of hospitals and after the initial care episode. Such studies require clear descriptions of how the costs of drug-related morbidity are measured, and should adhere to published guidelines for observational studies and economic evaluation studies.
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Vidal J, Benito P, Manresa A, Ly-Pen D, Batlle E, Blanco FJ, Brosa M, Nieves D. [Economic evaluation of tramadol/paracetamol in the management of pain in patients with osteoarthritis in Spain]. ACTA ACUST UNITED AC 2011; 7:241-7. [PMID: 21794825 DOI: 10.1016/j.reuma.2010.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 11/26/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the costs of treating osteoarthritis (OA) pain using combination tramadol/paracetamol tablets, Non-Steroidal Anti-Inflammatory Agents (NSAID) alone or NSAID plus proton pump inhibitors (PPI) from the perspective of the Spanish National Health System. METHODS A decision-analytical model was constructed to analyze the cost associated with three treatment strategies over 6 months. A cost-minimization approach was used, which considered data related to resource use, medication costs and costs for the treatment of adverse events. RESULTS In the base-case analysis, costs for 6 months of treatment of OA pain using tramadol/paracetamol were €232.86, compared with €274.60 for NSAID + PPI and €133.75 for NSAID alone. This provided a savings of €41.74 per patient over 6 months for tramadol/paracetamol compared with NSAID + PPI and a cost increase of €99.11 compared with NSAID alone. When renal adverse events associated with NSAID were considered, tramadol/paracetamol was cost saving compared with all NSAID-based regimens (saving €140.02 vs NSAID alone, €280.86 vs NSAID + PPI). CONCLUSION Based on the results of a theoretical decision-analytic model, the data obtained may suggest that tramadol/paracetamol is cost saving compared with NSAID + PPI for the treatment of OA pain over a period of 6 months. Tramadol/paracetamol is also cost saving compared with treatment with NSAID alone if considering renal adverse events.
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Affiliation(s)
- Javier Vidal
- Servicio de Reumatología, Hospital General Universitario de Guadalajara. Guadalajara. España
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6
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Annemans L. Pharmacoeconomic impact of adverse events of long-term opioid treatment for the management of persistent pain. Clin Drug Investig 2011; 31:73-86. [PMID: 21067250 DOI: 10.1007/bf03256935] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Opioids are the most powerful analgesic drugs currently available and consequently form an essential part of the treatment options for malignant and non-malignant chronic pain. However, the benefits of these medications can be offset by gastrointestinal adverse events such as nausea, vomiting and constipation, as well as adverse events affecting the CNS. These occur relatively frequently in patients receiving long-term opioids for pain relief and are a cause of additional patient suffering and reduced work and social functioning, measured as reductions in quality-of-life outcomes. Consequently, adverse events are often the cause of treatment non-compliance or discontinuation (non-persistence). A literature search was conducted using BIOSIS Previews, EMBASE, Cochrane Collaboration and MEDLINE databases to identify references with specific relevance to the measurement of health outcomes related to adverse events of long-term opioid treatment of chronic pain. The results of this search highlighted that clinical interventions required to manage adverse events associated with opioids, and to provide alternative methods of pain control, both incur direct costs. These are largely driven by the cost of medical consults and drug supplies. Indirect costs are generated from work absences and reduced social functioning. Estimated preference ratings, providing an insight into the trade-off between effective pain control and adverse events, have shown that utility decrements associated with an increase in adverse-event severity were similar in size to those caused by a shift from well controlled to poorly controlled pain. Given the rising prevalence of chronic pain conditions (affecting one in five adult Europeans), the direct and indirect costs incurred from the management of adverse events with long-term opioids are likely to be multiplied, contributing to the socioeconomic burden of chronic pain. For this reason, the adverse-event profile of opioid-based analgesics should be improved to achieve more efficient long-term pain control.
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Affiliation(s)
- Lieven Annemans
- Ghent University, Ghent, and Brussels University, VUB, Brussels, Belgium.
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7
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Annemans L. Pharmacoeconomic impact of adverse events of long-term opioid treatment for the management of persistent pain. Clin Drug Investig 2010. [PMID: 21067250 DOI: 10.2165/11536290-000000000-00000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Opioids are the most powerful analgesic drugs currently available and consequently form an essential part of the treatment options for malignant and non-malignant chronic pain. However, the benefits of these medications can be offset by gastrointestinal adverse events such as nausea, vomiting and constipation, as well as adverse events affecting the CNS. These occur relatively frequently in patients receiving long-term opioids for pain relief and are a cause of additional patient suffering and reduced work and social functioning, measured as reductions in quality-of-life outcomes. Consequently, adverse events are often the cause of treatment non-compliance or discontinuation (non-persistence). A literature search was conducted using BIOSIS Previews, EMBASE, Cochrane Collaboration and MEDLINE databases to identify references with specific relevance to the measurement of health outcomes related to adverse events of long-term opioid treatment of chronic pain. The results of this search highlighted that clinical interventions required to manage adverse events associated with opioids, and to provide alternative methods of pain control, both incur direct costs. These are largely driven by the cost of medical consults and drug supplies. Indirect costs are generated from work absences and reduced social functioning. Estimated preference ratings, providing an insight into the trade-off between effective pain control and adverse events, have shown that utility decrements associated with an increase in adverse-event severity were similar in size to those caused by a shift from well controlled to poorly controlled pain. Given the rising prevalence of chronic pain conditions (affecting one in five adult Europeans), the direct and indirect costs incurred from the management of adverse events with long-term opioids are likely to be multiplied, contributing to the socioeconomic burden of chronic pain. For this reason, the adverse-event profile of opioid-based analgesics should be improved to achieve more efficient long-term pain control.
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Affiliation(s)
- Lieven Annemans
- Ghent University, Ghent, and Brussels University, VUB, Brussels, Belgium.
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Vonkeman HE, Klok RM, Postma MJ, Brouwers JRBJ, van de Laar MAFJ. Direct medical costs of serious gastrointestinal ulcers among users of NSAIDs. Drugs Aging 2007; 24:681-90. [PMID: 17702536 DOI: 10.2165/00002512-200724080-00005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The occurrence and prevention of gastrointestinal ulcers during use of NSAIDs has become a major healthcare issue. OBJECTIVE To determine the direct medical costs of serious NSAID-related ulcer complications. METHOD An observational cost-of-illness study was conducted in a large general hospital serving a population of 152,989 persons. From November 2001 to December 2003 all consecutive patients hospitalised with serious NSAID-related ulcer complications were identified. Serious NSAID-related ulcer complications were defined as ulcerations of the stomach or proximal duodenum causing perforation, obstruction or bleeding that occurred during the use of NSAIDs, necessitating hospitalisation of the patient. Data were retrieved with respect to days hospitalised and the number and type of diagnostic and therapeutic interventions. The main outcome measure was estimated mean direct medical costs of resources used. RESULTS A total of 104 patients were hospitalised with serious NSAID-related ulcer complications (incidence 31.4 per 100,000 persons per year). Most patients were elderly (mean 70.4 years, SD 16.7). In-hospital mortality was 10.6%. Mean direct medical costs were euro 8375 (95% CI 7067, 10 393). On the basis of these results, we estimated that approximately 5105 people are hospitalised with serious NSAID-related ulcer complications in The Netherlands each year, of whom 541 die in hospital. The total annual direct medical costs for serious NSAID-related ulcer complications in The Netherlands were estimated to be euro 42,754 375 (95% CI 36 077 035, 53 056 265). CONCLUSIONS Serious NSAID-related ulcer complications have a mortality rate of 10.6% in The Netherlands and the annual direct medical costs to the country of such complications are approximately euro 42,750 000.
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Affiliation(s)
- Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente Hospital, and University of Twente, Enschede, The Netherlands.
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Utilización de recursos en una cohorte de pacientes con artritis reumatoide atendidos en área especializada de reumatología en España. ACTA ACUST UNITED AC 2005; 1:142-9. [DOI: 10.1016/s1699-258x(05)72733-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 04/19/2005] [Indexed: 11/22/2022]
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10
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Rahme E, Barkun AN, Adam V, Bardou M. Treatment costs to prevent or treat upper gastrointestinal adverse events associated with NSAIDs. Drug Saf 2005; 27:1019-42. [PMID: 15471508 DOI: 10.2165/00002018-200427130-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The widespread use of nonselective NSAIDs and cyclo-oxygenase (COX)-2 inhibitors has a substantial impact on healthcare budgets worldwide. The cost of their gastrointestinal (GI) adverse effects is a major component of their direct cost and has received much attention in the literature. Published studies have often differed in their methodologies and results. It is important for decision makers to understand the reasons for these differences in order to make informed decisions. We conducted a literature review to summarise data that evaluate the direct costs of NSAID-related GI adverse effects worldwide. This resulted in 789 articles from which 29 studies met the inclusion criteria and were fully reviewed. Of these 29, the 9 studies that assessed the cost of COX-2 inhibitors were all based on decision economic models, compared with only 7 of the remaining 20 studies, which assessed the cost of nonselective NSAIDs. In most studies, the perspective was that of the healthcare payer and the costs assessed were reimbursement costs. Costs of GI events almost doubled between regular users and non-users of nonselective NSAIDs and were much higher in high-dose versus low-dose users. The ratio of the total cost of nonselective NSAIDs to their acquisition cost reported in all studies varied from 1.36 to 2.12. Both of these numbers were reported in one single study assessing several different NSAIDs in France. Thus, the GI adverse events attributable to nonselective NSAIDs are substantial, and their costs often exceed the cost of the nonselective NSAID itself.The acquisition cost of the COX-2 inhibitors was the main driver of their total cost. The GI adverse effects with the COX-2 inhibitors added 10-20% to their acquisition cost in North America, while this increase was about 50% in some European countries. Decision analysis models showed that the direct costs of COX-2 inhibitors were lower than those of nonselective NSAIDs in patients at risk of NSAID gastropathy but higher in patients at no to low risk of gastropathy. Thus, from an economic perspective, the healthcare system would benefit from treating patients at risk of NSAID gastropathy with COX-2 inhibitors, but not those at no to low risk.
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Affiliation(s)
- Elham Rahme
- Department of Medicine, McGill University and Research Institute, McGill University Health Center, Montreal, Quebec, Canada.
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Doupe M, Katz A, Kvern B, Manness LJ, Metge C, Thomson GTD, Morrison L, Rother K. Encouraging physician appropriate prescribing of non-steroidal anti-inflammatory therapies: protocol of a randomized controlled trial [ISRCTN43532635]. BMC Health Serv Res 2004; 4:21. [PMID: 15327694 PMCID: PMC516782 DOI: 10.1186/1472-6963-4-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2004] [Accepted: 08/24/2004] [Indexed: 01/20/2023] Open
Abstract
Background Traditional non-steroidal anti-inflammatory drugs (NSAIDs) are a widely used class of therapy in the treatment of chronic pain and inflammation. The drugs are effective and can be relatively inexpensive thanks to available generic versions. Unfortunately the traditional NSAIDs are associated with gastrointestinal complications in a small proportion of patients, requiring costly co-therapy with gastro-protective agents. Recently, a new class of non-steroidal anti-inflammatory agents known as coxibs has become available, fashioned to be safer than the traditional NSAIDs but priced considerably higher than the traditional generics. To help physicians choose appropriately and cost-effectively from the expanded number of anti-inflammatory therapies, scientific bodies have issued clinical practice guidelines and third party payers have published restricted reimbursement policies. The objective of this study is to determine whether an educational intervention can prompt physicians to adjust their prescribing in accordance with these expert recommendations. Methods This is an ongoing, randomized controlled trial. All primary care physicians in Manitoba, Canada have been randomly assigned to a control group or an intervention study group. The educational intervention being evaluated consists of an audit and feedback mechanism combined with optional participation in a Continuing Medical Education interactive workshop. The primary outcome of the study is the change, from pre-to post-intervention, in physicians' appropriate prescribing of non-steroidal anti-inflammatory therapies for patients requiring chronic treatment. Three classes of non-steroidal anti-inflammatory therapies have been identified: coxib therapy, traditional NSAID monotherapy, and traditional NSAID therapy combined with gastro-protective agents. Appropriate prescribing is defined based on international clinical practice guidelines and the provincial drug reimbursement policy in Manitoba.
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Affiliation(s)
- Malcolm Doupe
- Primary Health Care Research Unit, St Boniface Research Centre, Winnipeg, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Primary Health Care Research Unit, St Boniface Research Centre, Winnipeg, Canada
- Department of Family Medicine, University of Manitoba, Winnipeg, Canada
| | - Brent Kvern
- Department of Continuing Medical Education, University of Manitoba, Winnipeg, Canada
| | - Lori-Jean Manness
- Department of Patient Health, Merck Frosst Canada Ltd., Kirkland, Canada
| | - Colleen Metge
- Faculty of Pharmacy, University of Manitoba, Winnipeg, Canada
| | - Glen TD Thomson
- CIADS Research, Centre for Inflammatory and Arthritic Disease Studies, Winnipeg, Canada
| | - Laura Morrison
- Primary Health Care Research Unit, St Boniface Research Centre, Winnipeg, Canada
| | - Kat Rother
- Primary Health Care Research Unit, St Boniface Research Centre, Winnipeg, Canada
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Stephens JM, Bell CF, Wong JM, Peña BM, Haider S, Pashos CL. Value of cyclooxygenase-2 specific inhibitors in the management of osteoarthritis. Expert Rev Pharmacoecon Outcomes Res 2004; 4:441-55. [PMID: 19807303 DOI: 10.1586/14737167.4.4.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Osteoarthritis is the most common form of arthritis and causes substantial morbidity and healthcare expenditure worldwide. This is partly due to the gastrointestinal side effects associated with the use of nonspecific nonsteroidal anti-inflammatory drugs. Cyclooxygenase-2 specific inhibitors offer a therapeutic alternative since they may reduce gastrointestinal-related risks with a similar clinical efficacy to nonsteroidal anti-inflammatory drugs. This article provides an overview of the clinical and economic value of cyclooxygenase-2 specific inhibitors in the management of osteoarthritis. The authors' findings suggest that cyclooxygenase-2 specific inhibitors show comparable efficacy with nonspecific nonsteroidal anti-inflammatory drugs, yet have reduced rates of gastrointestinal complications. Pharmacoeconomic studies have demonstrated the cost-effectiveness of prescribing cyclooxygenase-2 specific inhibitors in certain high-risk populations. Cyclooxygenase-2 specific inhibitors provide clinical and economic benefits in patients diagnosed with osteoarthritis. Future studies should further examine the economic implications of newer cyclooxygenase-2 inhibitors and quantify the impact of pain management on patients' quality of life.
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Affiliation(s)
- Jennifer M Stephens
- Abt Associates Clinical Trials, HERQuLES Group, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, USA.
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13
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Affiliation(s)
- Z Mahmood
- Department of Gastroenterology, Adelaide and Meath Hospitals, Dublin, Ireland
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14
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Abstract
The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is common in patients with osteoarthritis and rheumatoid arthritis. However, due to gastrointestinal side effects, the health-related and economic burden related to these drugs is considerable. Therefore, substituting or supplementing conventional NSAIDs with safer drugs that have a better risk profile not only may avoid serious complications but may also be an efficient allocation of scarce resources. Because of their better gastrointestinal risk profile, the newly developed selective COX-2 inhibitors celecoxib and rofecoxib are discussed as cost-effective alternatives to common NSAIDs. This paper provides an overview of health economic evaluations, conducted during the last few years, that investigate the economic consequences of switching patients from traditional NSAIDs to selective COX-2 inhibitors. This review of the health economic literature shows that results of the health economic assessments of COX-2 inhibitors are highly contradictory. The main divergence between studies occurs in estimated economic consequences of adopting COX-2 inhibitors in patients at low or average risk for developing gastrointestinal side effects. The economic consequences of the introduction of COX-2 inhibitors as well as the asynchronous development of scientific acceptance of the benefit of the new drugs and their actual diffusion and spread are discussed taking a broader, healthcare-system perspective.
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Affiliation(s)
- David L B Schwappach
- Lehrstuhl für Gesundheitspolitik und -management, Fakultät der Medizin, Universität Witten/Herdecke, Alfred-Herrhausen-Strasse 50, D-58448 Witten, Germany.
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Rodríguez-Monguió R, Otero MJ, Rovira J. Assessing the economic impact of adverse drug effects. PHARMACOECONOMICS 2003; 21:623-650. [PMID: 12807365 DOI: 10.2165/00019053-200321090-00002] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Although most commonly used drugs cause adverse effects, some of them with potentially serious consequences, relatively little is known about their economic impact. The purpose of this review is to summarise information describing the cost of treatment of drug-induced adverse effects as an additional cost of pharmaceutical treatment. The focus of this study was limited to the overall economic impact of drug-related morbidity and to the economic analysis of a single class of drugs with different safety profiles. Several studies carried out in the US have investigated adverse drug effects experienced by hospitalised patients and their impact on hospital costs. Patients who developed adverse effects were hospitalised an average of 1.2-3.8 days longer than patients who did not, with additional hospital costs of $US2284-5640 per patient (2000 values). Other research studies in different countries have quantified the incidence and economic consequences of adverse drug effects that occur in the ambulatory setting and that generate hospital admission and emergency department visits. They have shown that preventable adverse effects constitute between 43.3% and 80% of all adverse outcomes leading to emergency visits and hospital admissions, and disproportionately increase healthcare costs. Finally, a recent estimation revealed that in the US the cost of problems linked to drug use in the ambulatory setting exceeded $US177 billion in the year 2000.NSAIDs constitute a widely used class of drugs and they are one of the leading drug classes in causing adverse effects. The acquisition costs of the drugs, as well as the costs for prevention and treatment of adverse effects, determine their cost-effectiveness ratio. Depending on the incidence and severity of adverse effects, the cost per adverse effect avoided ranges from $US215 to $US35 459 (2000 values). According to the contingent valuation methodology, willingness to pay to avoid or reduce the incidence of adverse effects is an indicator of the value individuals associate with the impact of such effects on their well-being. Individuals are willing to pay annually an average of $US240 and $US350, respectively, to avoid vomiting and gastrointestinal distress induced by NSAIDs. Although the results of the different studies reviewed are not strictly comparable because of differences in the severity of adverse effects, the perspective of the analysis, the cost data included and the cost component considered, the data show that, apart from the implications for health, a substantial quantity of resources are used to treat adverse effects.
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Affiliation(s)
- Rosa Rodríguez-Monguió
- Grup de Recerca en Economia de la Salut y Seguretat Social, Universidad de Barcelona, Barcelona, Spain.
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Abstract
The economic evaluation of health care programs is undertaken to assess health care costs and benefits. Part of the goal of cost-effectiveness analysis is to maximize health benefits given the constraint of limited health care resources. The identification of costs is critical in a cost-effectiveness analysis of clinical interventions. The recent introduction of the cyclooxygenase (COX)-2-selective inhibitors, coxibs, for treatment of rheumatoid arthritis, osteoarthritis, and acute pain gives rise to cost-effectiveness issues. These new agents provide similar efficacy with fewer gastrointestinal events compared with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), but are more expensive on a per-dose basis. However, several modeled cost analyses have suggested that COX-2 inhibitors are cost effective in subsets of patients because they are associated with fewer downstream costs, particularly medical and surgical treatment of gastrointestinal adverse effects. Three cost-effectiveness models of interventions for rheumatoid arthritis and osteoarthritis, including COX-2 inhibitors, are reviewed. Prospective clinical investigation of the potential costs and benefits of these new agents is necessary to further support these findings.
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Affiliation(s)
- Scott B Cantor
- Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2001; 10:345-60. [PMID: 11760498 DOI: 10.1002/pds.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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