PMID- 11280106
OWN - NLM
STAT- MEDLINE
DCOM- 20010412
LR  - 20181113
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 19 Suppl 1
DP  - 2001
TI  - Economic evaluation of celecoxib, a new cyclo-oxygenase 2 specific inhibitor, in 
      Switzerland.
PG  - 59-75
AB  - OBJECTIVE: The aim of this study was to predict the cost effectiveness of 
      celecoxib, a cyclo-oxygenase 2 (COX-2) specific inhibitor, in the treatment of 
      arthritis patients in Switzerland. METHODS: We applied a decision analytical 
      model to compare the effects of 6 months' treatment with the following: (i) 
      celecoxib; (ii) nonsteroidal anti-inflammatory drug (NSAID) alone; NSAID 
      protected with (iii) proton pump inhibitor (PPI), (iv) histamine H2 receptor 
      antagonist (H2RA), or (v) misoprostol; and (vi) diclofenac/misoprostol. Treatment 
      costs included drug acquisition and the management of gastrointestinal (GI) 
      adverse effects, classified as GI discomfort, symptomatic ulcer, anaemia and 
      serious GI events (requiring hospitalisation). Probabilities were derived from 
      celecoxib clinical trials and the literature. Drug utilisation patterns and 
      treatment costs reflecting Swiss practice were obtained from local sources. 
      Analysis was from the public health insurers' perspective. A range of sensitivity 
      analyses was performed. RESULTS: For the base case of patients at typical risk 
      (0.56% per 6 months) of serious GI events, the total expected costs of 6 months' 
      treatment were as follows: celecoxib 435 Swiss francs (SwF); NSAID alone SwF510; 
      diclofenac/misoprostol SwF522; and other protected NSAID regimens between SwF1034 
      and SwF1415. Celecoxib remained the lowest costing treatment over all categories 
      of GI risk. Celecoxib generated 115 expected adverse events per 1000 patients per 
      6 months, followed by NSAID + PPI (119), NSAID + H2RA (154), NSAID + misoprostol 
      (202), diclofenac/misoprostol (203), and NSAID alone (220), again for the base 
      case. The cost per adverse event averted for celecoxib compared with NSAIDs alone 
      was estimated in a stochastic version of the model using Monte Carlo simulation. 
      In 95% of 500 iterations, celecoxib was predicted to save both costs and adverse 
      events, thus dominating NSAIDs alone; the maximum cost per adverse event averted 
      was SwF440. CONCLUSIONS: Celecoxib is predicted to be the most cost effective of 
      the treatments considered for managing arthritis patients in Switzerland. A 
      policy of switching patients from NSAIDs to celecoxib is predicted to be cost 
      saving for public health insurers, while reducing the burden of iatrogenic GI 
      side effects. Greater cost savings would be realised when patients are switched 
      from NSAIDs used with gastroprotective agents. Models such as this can provide a 
      useful but simplified view of treatment outcomes and predicted results require 
      prospective validation in clinical practice.
FAU - Chancellor, J V
AU  - Chancellor JV
AD  - Pharmacia Corporation, Global Health Outcomes, High Wycombe, UK. 
      jeremy.chancellor@ea.monsanto.com
FAU - Hunsche, E
AU  - Hunsche E
FAU - de Cruz, E
AU  - de Cruz E
FAU - Sarasin, F P
AU  - Sarasin FP
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Cyclooxygenase Inhibitors)
RN  - 0 (Pyrazoles)
RN  - 0 (Sulfonamides)
RN  - JCX84Q7J1L (Celecoxib)
MH  - Anemia/chemically induced/economics
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/economics/therapeutic 
      use
MH  - Anti-Ulcer Agents/*economics/therapeutic use
MH  - Arthritis/*drug therapy
MH  - Celecoxib
MH  - Clinical Trials as Topic
MH  - *Cost of Illness
MH  - Cost-Benefit Analysis
MH  - Cyclooxygenase Inhibitors/*economics/therapeutic use
MH  - Decision Trees
MH  - Drug Therapy, Combination
MH  - Duodenal Ulcer/chemically induced/economics
MH  - *Economics, Pharmaceutical
MH  - Humans
MH  - Probability
MH  - Pyrazoles
MH  - Sulfonamides/*economics/therapeutic use
MH  - Switzerland
EDAT- 2001/03/31 10:00
MHDA- 2001/04/17 10:01
CRDT- 2001/03/31 10:00
PHST- 2001/03/31 10:00 [pubmed]
PHST- 2001/04/17 10:01 [medline]
PHST- 2001/03/31 10:00 [entrez]
AID - 10.2165/00019053-200119001-00005 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2001;19 Suppl 1:59-75. doi: 10.2165/00019053-200119001-00005.