Impact of selective cyclooxygenase‐2 inhibitors on anti‐ulcer medication and non‐steroidal anti‐inflammatory drug use in patients with rheumatic disease

Joshua, Fredrick; Oakley, Stephen P.; Major, Gabor

doi:10.1111/j.1444-0903.2004.00515.x

Cited by 6 publications

(12 citation statements)

References 13 publications

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“…We stand by the conclusions in our paper 1 (editorialized in the same issue of Internal Medicine Journal ) 2 . The study was conducted in a clinical setting and although the economic analysis was of limited scope, we feel that the results are relevant to the understanding of the costs and benefits arising from everyday prescribing practice.…”

mentioning

confidence: 86%

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Major

Oakley²,

Joshua

2004

Internal Medicine Journal

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We welcome the contribution from Dr Fenn and colleagues to the debate regarding the costs and benefits of selective cyclooxygenase-2 (COX-2) inhibitor use. It is a complex issue and one greatly in need of further study.We stand by the conclusions in our paper 1 (editorialized in the same issue of Internal Medicine Journal ). 2 The study was conducted in a clinical setting and although the economic analysis was of limited scope, we feel that the results are relevant to the understanding of the costs and benefits arising from everyday prescribing practice. We found that selective COX-2 inhibitor prescription not only replaced a large portion of conventional nonsteroidal anti-inflammatory drug use, but also increased the percentage of patients on anti-inflammatory therapy from 48 to 77%, with a commensurate increase in overall anti-inflammatory drug expenditure.The cost calculations, method of analysis and any assumptions are fully detailed. For instance, in considering the risk of serious gastrointestinal (GI) complication, we assumed the celecoxib-associated risk to be the same as placebo -an assumption that could be seen as overly generous. 2 Fenn et al . refer to a cost-effectiveness study (as opposed to our cost-benefit analysis) that had been undertaken by Grobler et al . from Pharmacia and presented as a poster at the 2003 Annual Scientific meeting of the Australian Rheumatology Association. The study was based on a meta-analysis of celecoxib clinical trial data, some of which has been published in full in peer-reviewed literature, and calculated the economic benefit in terms of 'effectiveness' at $16 918 per life year gained through selective COX-2 inhibitor use.The problems surrounding pharmacoeconomic analysis have been highlighted in numerous reviews, including a recent editorial in this journal. 3 The consistent theme in all of them, however, is the need to fully describe all aspects of the methodology, including data sourcing, assumptions, etc. The difference between our findings and the report by Grobler et al . illustrates the importance of this, and the influence that setting and approach can have on the 'bottom line' figure. While the Grobler et al . analysis is only available in abstract form 4 and it is difficult, therefore, to attempt a detailed comparison, it is evident that the two analyses look at different end-points (serious GI event vs life years gained), and, importantly, also sourced data very differently. One is a calculation derived from clinical trial data, whereas the other attempts a 'real life' analysis of direct costs from survey findings in routine clinical setting. Neither approach gives a complete picture of all costs and benefits. For instance, factors such as nonserious GI events, changes in productivity in the now extended population on anti-inflammatory therapy, and the non-GI risks/benefits were not considered.The conclusion by Fenn et al . that any increased expenditure directly related to coxib use is valuable, is a conclusion we would not necessarily disagree with, but i...

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confidence: 86%

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Major

Oakley²,

Joshua

2004

Internal Medicine Journal

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“… † Note that Joshua et al . 1 reported on p. 154 that the ‘pre‐release’ data were sampled in 1998, but this statement was referenced to a 1993 study (query whether this is a referencing error or a typo); ‡ Taken or derived from Joshua et al. Table 6, p. 159; § Taken or derived from Joshua et al.…”

Section: Relative Contribution Of Nsaid Coxib and Anti‐ulcer Medicatmentioning

confidence: 99%

“…The cost‐benefit analysis by Joshua et al . showed that the net cost of ‘the introduction of COX‐2 inhibitors’ was $71 736 per serious GI hospital admission prevented (p. 153) 1 . We wish to stress that this limited (author's words) cost‐benefit analysis should not be confused as a cost‐effectiveness analysis of Coxibs.…”

Section: Cost‐effectiveness Datamentioning

confidence: 99%

“…The paper by Joshua et al . presents valuable survey data showing changing rheumatology prescribing trends in the Newcastle region in recent years; 1 however, we wish to raise one major concern about the ‘cost‐benefit analysis’ (not to be confused with ‘cost‐effectiveness analysis’) that was also presented in the paper. We consider that the conclusion ‘the introduction of selective COX‐2 inhibitors has been associated with a significant increase in expenditure’, although true, is incomplete in two ways.…”

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confidence: 99%

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