COX-2 Inhibitors May Not Be Cost-Effective--Study

December 16, 2003

NEW YORK (Reuters Health) Dec 15 - New research by US investigators suggests

that practice pattern models may have overestimated the cost-effectiveness

of selective COX-2 inhibitors, such as celecoxib (Celebrex) and rofecoxib

(Vioxx).

Previous reports have suggested that such agents are a cost-effective

alternative to nonselective NSAIDS because they reduce the need for

gastroprotective agents (GPA). But, the current results suggest just the

opposite: GPA use is higher among COX-2 users than among nonselective NSAID

users.

" These findings call into question the use of expert opinion in estimating

practice pattern model inputs prior to a product's use in clinical practice,

warranting a re-evaluation of COX-2 cost effectiveness models, " lead author

Dr. R. , from Express Scripts, Inc. in land Heights, Missouri,

said in a statement.

The report is published in the December issue of The American Journal of

Managed Care.

In the new study, medical claims data from a preferred provider organization

in the Midwest was used to estimate GPA use for 1900 new NSAID users, 289

new NSAID users with diagnosis of arthritis, and 1232 matched NSAID users.

In each of the groups, GPA rates were higher among COX-2 users than among

users of nonselective NSAIDS. For example, in the new NSAID group, 22% of

COX-2 users used GPAs, whereas only 15% of nonselective NSAID users used

GPAs.

Re-estimation of the COX-2 cost-effectiveness model based on the GPA

findings revealed a more than $80,000 increase in the cost per life year

saved.

" The harm from incorrect assumptions, such as those found in the

cost-effectiveness evaluations of COX-2s, is that they undermine the

efficient allocation of scarce healthcare resources, " Dr. emphasized.

Still, further studies are needed to determine if more harm than good

actually came from the false assumptions, the researchers conclude.

Am J Managed Care 2003;9:785-794.

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