Costs and effects of various analgesic treatments for patients with rheumatoid arthritis and osteoarthritis in The Netherlands

Objective: To assess the balance between costs and upper gastrointestinal (GI) side effects of treatment with celecoxib, nonsteroidal antiinflammatory drugs (NSAIDs) alone, NSAID plus misoprostol, NSAID plus histamine-2 receptor antagonist (H(2)RA), NSAID plus proton pump inhibitor (PPI), and Arthrotec in The Netherlands. Methods: A model was used to convene data from various sources on the probability of GI side effects and resource use. The probabilities of GI side effects for celecoxib and NSAIDs alone were derived from trial data. Calculations were based on 6 months of treatment, and were from a societal perspective. Distinction was made between low-, medium-, and high-risk patients. An extensive probabilistic sensitivity analysis was performed to address uncertainty. Results: Assuming an average patient, the total costs per 6 months of therapy were: celecoxib (sic)255, NSAIDs alone (sic)166, NSAID plus misoprostol (sic)285, NSAID plus H(2)RA (sic)284, NSAID plus PPI (sic)243, and Arthrotec (sic)187. Treatment with celecoxib was associated with the lowest number of GI side effects and related deaths. Incremental costs per life-year saved for Arthrotec compared to NSAIDs alone were (sic)5676 for all patients and (sic)526 for medium-to-high-risk patients, whereas for high-risk patients, Arthrotec dominated NSAID alone. For celecoxib compared to Arthrotec, the incremental cost-effectiveness ratios (ICERs) were (sic)56,667, (sic)33,684, and (sic)15,429, respectively. Conclusion: Assuming a limit of (sic)20,000 per life-year gained, from an economic point of view, Arthrotec is the preferred treatment when all patients or medium-to-high-risk patients are considered. In high-risk patients, celecoxib is the preferred treatment strategy.