A new study demonstrates that a popular class of arthritis drugs is not as cost-effective as common painkillers in treating chronic arthritis in an average patient.
The University of California Los Angeles (UCLA) and Veterans Affairs Greater Los Angeles Healthcare System study, published in the May 20 issue of the journal Annals of Internal Medicine, shows that popular arthritis drugs developed to help avoid the gastrointestinal problems associated with anti-inflammatory drugs may not be any more cost-effective than these common painkillers. The study found that cyclooxygenase-2 selective inhibitor drugs (Coxibs) such as rofecoxib (Vioxx) and celecoxib (Celebrex) are not as cost-effective as non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen, in treating an average chronic arthritis patient. The study may lead to increased use of the less expensive NSAIDs to treat arthritis.
Coxibs offer the same pain relief, but without the gastrointestinal problems associated with taking NSAIDs. The UCLA study, however, found that this benefit did not offset the increased cost of using Coxibs to treat most arthritis. Coxibs did appear cost-effective, however, in treating the small subset of patients with a history of severe gastrointestinal complications.
UCLA’s lead author, Dr. Brennan Spiegel, a fellow in gastroenterology and health services research, noted that previous studies have shown Coxibs to provide a less than 1 percent absolute risk reduction, as compared to the less costly generic NSAIDs, in the prevention of significant ulcer complications.
“We hope that this study will help guide primary-care providers, rheumatologists, pain-management physicians, health insurance companies and patients in developing the best treatment plans to meet individual needs for chronic arthritis,” said senior author Dr. Ian Gralnek, assistant professor, David Geffen School of Medicine at UCLA, Veterans Affairs Greater Los Angeles Healthcare System and CURE Digestive Diseases Research Center.
More than 15 percent of Americans suffer from chronic arthritis, including osteoarthritis and rheumatoid arthritis. In the UCLA study, researchers used a sophisticated economic model to develop patient scenarios and compare the costs between Coxibs and NSAIDs.
Researchers used a standard measure used in assessing the outcome of health-care procedures or services called the quality-adjusted life year. The measurement is designed to take into account health-related quality of life as well as the duration of survival.
Researchers found that for an average 60-year-old arthritis patient with no prior gastrointestinal problems, the cost per quality-adjusted life year gained by using a Coxib compared to a NSAID is more than a quarter million dollars, or $275,809.
Spiegel notes that the general cost-effectiveness standard accepted by society, and many insurers, for treating a chronic condition like arthritis is roughly $50,000 or less per quality-adjusted life year gained.
“The cost of using Coxibs was significantly higher than we thought,” Spiegel said. “Even if an insurer were willing to pay up to $150,000 per quality-adjusted life year for the use of Coxibs, only 4 percent of patients would fall into this budget — everyone else would have much higher costs.”
However, the UCLA study also found that for the small subset of arthritis patients with a history of severe gastrointestinal complications like ulcer bleeds, Coxibs proved potentially cost-effective — at $55,803 per quality-adjusted life year.
Gralnek added that his team even strongly biased the economic model to favor Coxibs, yet the study still revealed that this class of drugs was not cost-effective for most arthritis patients. For example, in the model, any development of gastrointestinal symptoms from NSAID use was treated very aggressively, thus adding more costs to the anti-inflammatory side.
The study was funded in part by the National Institutes of Health and a Veterans Affairs Health Services Research and Development Award.