Pam9: Cost Comparison of Treating Rheumatoid Arthritis Patients With Cox-2 Inhibitors or Nsaids in a Managed Care Population

Abstract

OBJECTIVE: To compare rheumatoid arthritis (RA) treatment charges with a cyclooxygenase‐2 specific inhibitor (COX‐2) versus a non‐steroidal anti‐inflammatory drug (NSAID) therapies in a managed care population. METHODS: Patients with a diagnosis of RA between January 1 and June 30, 1999 who had prescriptions for COX‐2s or NSAIDs were selected from the PharMetrics Integrated Outcomes Database. Patients were excluded if they had osteoarthritis or did not have 6 months of continuous enrollment following the first (index) COX‐2 or NSAID pharmacy claim. COX‐2 and NSAID‐treated groups were compared on their demographics, comorbidities, and total RA‐specific charges during the 6 month follow‐up period RESULTS: A total of 5,261 patients met the patient selection criteria, including 668 who received COX‐2 and 4,593 who received NSAID. The COX‐2 group was older (53.7 versus 49.6 years, p < 0.0001) on average and more likely to have at least one comorbidity (46.0% vs. 31.9%, p < 0.001) compared to the NSAID group. They also had higher RA‐related pharmacy ($914 versus $636) and medical charges ($611 versus $566). Total mean charges for the COX‐2 cohort were $323 higher (p = 0.019) than the NSAID cohort. CONCLUSION: In this initial cost comparison between COX‐2s and NSAIDs, the mean charge for a 6‐month period with COX‐2s was 27% higher than with NSAIDs, mainly due to higher pharmacy charges. Longer‐term studies are required to examine whether the higher acquisition costs of COX‐2 are offset by savings in the costs of treating gastrotoxicity.