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VBCR - December 2015, Volume 4, No 6 - Value Propositions

After reporting on the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in osteoarthritis at the 2015 Osteoarthritis Research Society International World Congress in Seattle, WA, Jeffrey Katz, MD, and colleagues have published online their findings on the cost-effectiveness of NSAIDs in the treatment of older patients with OA and multiple comorbidities.

The study assessed the long-term clinical and economic effects of treatment with naproxen, ibuprofen, celecoxib, or tramadol for OA patients with cardiovascular disease and diabetes. Researchers used the Osteoarthritis Policy Model to evaluate the use of these study agents after standard-of-care treatment with acetaminophen and corticosteroid injections no longer controlled pain. Treatments evaluated included NSAID regimens with and without proton pump inhibitors (PPIs) and over-the-counter (OTC) drugs. Published reports were used to estimate efficacy (pain reduction in approximately 57% of patients), major cardiac or gastrointestinal toxicity, or fractures (risk of fractures was 1.09% with celecoxib and 5.62% with tramadol). Data from Red Book Online determined annual costs.

Results showed that adding ibuprofen to standard-of-care treatment increased quality-adjusted life-years (QALYs) by 0.07 and decreased costs by $800. Adding OTC naproxen instead of ibuprofen increased QALYs by 0.01 and costs by $300; with this regimen, the incremental cost-effectiveness ratio (ICER) was $54,800/QALY. With prescription naproxen and OTC PPIs the ICER was $76,700/QALY, and with prescription naproxen with prescription PPIs the ICER was $252,300/QALY. Treatment plans that included tramadol or celecoxib added fewer QALYs despite their higher cost.

In this study, regimens containing naproxen and ibuprofen were clinically superior and more cost-effective in treating OA pain in patients with comorbidities than opioids, celecoxib, or standard of care.

Katz JN, et al. Osteoarthritis Cartilage. October 22, 2015. [Published online ahead of print]

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