Minimizing complications from nonsteroidal antiinflammatory drugs: Cost‐effectiveness of competing strategies in varying risk groups

Abstract

Objective. To appraise the cost-effectiveness of competing therapeutic strategies in patient cohorts eligible for aspirin prophylaxis with varying degrees of gastrointestinal (GI) and cardiovascular risk. Methods. Cost-effectiveness and cost-utility analyses were performed to evaluate 3 competing strategies for the management of chronic arthritis: 1) a generic nonselective nonsteroidal antiinflammatory drug (NSAID NS ) alone; 2) NSAID NS plus a proton pump inhibitor (PPI); and 3) a cyclooxygenase 2-selective inhibitor (coxib) alone. Cost estimates were from a third-party payer perspective. The outcomes were incremental cost per ulcer complication avoided and incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was performed to evaluate the impact of varying patient GI risks and aspirin use. Results. In average-risk patients, the NSAID NS ؉ PPI strategy costs an incremental $45,350 per additional ulcer complication avoided and $309,666 per QALY gained compared with the NSAID NS strategy. The coxib strategy was less effective and more expensive than the NSAID NS ؉ PPI strategy. Sensitivity analysis revealed that the NSAID NS ؉ PPI strategy became the dominant approach in patients at high risk for an NSAID adverse event (i.e., patients taking aspirin with >1 risk factor for a GI complication). Conclusion. Generic nonselective NSAIDs are most cost-effective in patients at low risk for an adverse event. However, the addition of a PPI to a nonselective NSAID may be the preferred strategy in patients taking aspirin or otherwise at high risk for a GI or cardiovascular adverse event.

Prevention and treatment of NSAID-induced gastroduodenal injury

“…Blood pressure should be monitored, especially in those with a history of hypertension. Cost effectiveness Coxibs are cost effective in patients with risk factors [31,43].…”

A Unified Framework for Classification of Methods for Benefit-Risk Assessment

“…These preference weights can reflect utilities measured using standard gamble (SG), time trade-off (TTO), or indirect (e.g., EuroQol fivedimensional questionnaire, six-dimensional health state short form [derived from short-form 36 health survey], and health utilities index 3) methods. We have assigned EuroQol fivedimensional questionnaire utilities to each health state on the basis of published studies [12][13][14][15] and present preference weights elicited using a discrete choice experiment (DCE) [16]. We also provide assumptions about the duration of each health state.…”

Nonsteroidal anti-inflammatory drugs: cyclooxygenase 2 inhibitors

“…Idade avançada, doença ulcerosa péptica prévia, sangramento prévio e uso concomitante de outro AINH ou corticosteróide são fatores de risco para as complicações gástricas como as ulcerações de mucosa, a esofagite de refluxo, o estreitamento esofagiano e a úlcera péptica 23 . Como esses efeitos são mediados principalmente pela inibição da Cox 1, acreditava-se que os inibidores seletivos da Cox 2 seriam uma alternativa mais segura.…”

“…Um estudo com 381 adultos que apresentavam reação pseudoalérgica aos AINH observou boa tolerância à nimesulida e ao meloxicam 23 .…”