Cycloxygenase-2 selective non-steroidal anti-inflammatory drugs (etodolac, meloxicam, celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib) for osteoarthritis and rheumatoid arthritis: a systematic review and economic evaluation

The aims of this review are four-fold: To undertake a systematic review of the clinical effectiveness and cost-effectiveness of cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs), including etodolac, meloxicam celecoxib, rofecoxib, etoricoxib, valdecoxib and lumiracoxib, for osteoarthritis (OA) and rheumatoid arthritis (RA). To assess the cost-effectivenessof COX-2 selective NSAIDs from an NHS perspective. To explore the potential impact of concomitant gastroprotective agents, with either COX-2 selective NSAIDs, or other non-selective NSAIDs, on the incidence of symptomatic gastrointestinal (GI) ulcers and complications such as bleeding, perforation or gastric outlet obstruction. To explore the impact of low-dose aspirin (<= 325 mg/ day) used in conjunction with COX- 2 selective NSAIDs on the incidence of cardiovascular ( CV) adverse events and symptomatic upper gastrointestinal (UGI) ulcers and their complications.