The economic and clinical burden of early versus late initiation of celecoxib among patients with osteoarthritis

Abstract

ObjectiveThis study aimed to evaluate the characteristics associated with early versus late initiation of celecoxib treatment after osteoarthritis (OA) diagnosis and whether economic and safety outcomes differ between patients with early versus late initiation of celecoxib.MethodsAdults (≥18 years) with a confirmed OA diagnosis (International Classification of Diseases, 9th Edition, Clinical Modifications code: 715.XX), ≥12 months of continuous pre- and post-index enrollment, and ≥1 post-index claim for celecoxib were included from the MarketScan® Commercial Claims and Encounter Database (2009–2013). Index date was defined as initial OA diagnosis. Patients were categorized as initiating celecoxib early (within 6 months of index date) or late (≥6 months after index date). Logistic regressions were used to assess characteristics associated with early versus late celecoxib initiation. Key outcomes included health care resource utilization (HCRU) and costs post-index, and adverse event incidence post-celecoxib initiation. Unadjusted and adjusted comparisons (using generalized linear models with a gamma distribution for costs and Poisson distribution for event and resource utilization) were made between early and late celecoxib initiators.ResultsOf the 62,434 OA patients identified, 27,402 were early and 35,032 were late initiators. Post-index hospital admissions and length of stay did not differ statistically between early versus late initiators after controlling for pre-index event rates and covariates, but early patients had significantly fewer outpatient (incidence rate ratio [IRR]: 0.96; 95% confidence interval [CI]: 0.95, 0.97) and emergency room visits (IRR: 0.89; 95% CI: 0.84, 0.95). After adjustment for key covariates, early initiators (versus late initiators) had lower all-cause (US$12,909 versus US$13,781, P<0.001) and OA-related (US$4,988 versus US$5,178, P=0.015) costs per person-year. Early initiators had no statistically significant difference in the incidence of post-celecoxib cardiovascular (IRR: 0.92; 95% CI: 0.73, 1.14), gastrointestinal (IRR: 1.25; 95% CI: 0.81, 1.92), or renal (IRR: 1.19; 95% CI: 0.65, 2.18) events, controlling for pre-index event rates and covariates when compared to late initiators.ConclusionIn this real-world cohort, patients initiated on celecoxib early (versus late) had significantly lower costs and HCRU; this may warrant consideration when making treatment decisions for OA patients.

<p>Economic Outcomes Related to Persistence and Dosing of Celecoxib in Patients with Osteoarthritis (OA) Using a Retrospective Claims Database Analysis</p>

“…OA-related costs were between $5000 and $6000 per patient year (PPY), within the range of previously reported costs ($5000-$7000 per patient year), [24][25][26] and were higher in persistent celecoxib patients compared with those who switched to a generic NSAID. However, over 45% of OA-related costs for persistent patients were drug-related versus only 19% in patients that switched to NSAIDs.…”

Duration of Treatment Effect Should Be Considered in the Design and Interpretation of Clinical Trials: Results of a Discrete Choice Experiment

“…23,26,49 The DCE sample was also representative in terms of the sites of osteoarthritis occurrence; many participants had osteoarthritis at multiple sites, with knee osteoarthritis being the most common, followed by hip osteoarthritis and then hand osteoarthritis. [50][51][52][53] Overall, the results on the importance of symptom relief and risks of serious events are in line with the results of a previous DCE on osteoarthritis medication by Hauber et al 18 The DCE by Hauber et al was based on symptom relief 1 h after taking osteoarthritis medication and assumed that the treatment effect did not degrade over time. Both studies found that stiffness was relatively unimportant.…”

“…23,26,49 The DCE sample was also representative in terms of the sites of osteoarthritis occurrence; many participants had osteoarthritis at multiple sites, with knee osteoarthritis being the most common, followed by hip osteoarthritis and then hand osteoarthritis. 50–53…”

Cost-Effectiveness Assessment of Different Glucosamines in Patients with Knee Osteoarthritis: A Simulation Model Adapted to Germany

“…In another microsimulation study, a diet and exercise programme in addition to treatment in overweight and obese patients with knee OA showed ICERs of $34,100/QALY and $30,000/QALY from the health care sector perspective and the societal perspective, respectively [29]. NSAIDS, recommended by ESCEO and other scientific societies, has also been shown to be cost effective, even with OA subjects with comorbidities [30][31][32][33]. Numerous medicoeconomic evaluations are also available showing the cost-effectiveness of hyaluronic acid injection in the management of OA [34][35][36].…”