PMID- 15818647
OWN - NLM
STAT- MEDLINE
DCOM- 20050505
LR  - 20151119
IS  - 0004-3591 (Print)
IS  - 0004-3591 (Linking)
VI  - 53
IP  - 2
DP  - 2005 Apr 15
TI  - Minimizing complications from nonsteroidal antiinflammatory drugs: 
      cost-effectiveness of competing strategies in varying risk groups.
PG  - 185-97
AB  - 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 
      US dollars per additional ulcer complication avoided and 309,666 US dollars 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 > or =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.
FAU - Spiegel, Brennan M R
AU  - Spiegel BM
AD  - Veteran's Affairs Greater Los Angeles Healthcare System, David Geffen School of 
      Medicine at University of California Los Angeles, Los Angeles, California 90073, 
      USA. bspiegel@mednet.ucla.edu
FAU - Chiou, Chiun-Fang
AU  - Chiou CF
FAU - Ofman, Joshua J
AU  - Ofman JJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PL  - United States
TA  - Arthritis Rheum
JT  - Arthritis and rheumatism
JID - 0370605
RN  - 0 (2-Pyridinylmethylsulfinylbenzimidazoles)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Lactones)
RN  - 0 (Proton Pump Inhibitors)
RN  - 0 (Pyrazoles)
RN  - 0 (Sulfonamides)
RN  - 0 (Sulfones)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - 0QTW8Z7MCR (rofecoxib)
RN  - 57Y76R9ATQ (Naproxen)
RN  - JCX84Q7J1L (Celecoxib)
RN  - KG60484QX9 (Omeprazole)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - Arthritis Rheum. 2006 Apr 15;55(2):338-9; author reply 339-40. PMID: 16583386
MH  - 2-Pyridinylmethylsulfinylbenzimidazoles
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects/economics
MH  - Arthritis/complications/*drug therapy/economics
MH  - Aspirin/therapeutic use
MH  - Celecoxib
MH  - Cost-Benefit Analysis
MH  - Drug Therapy, Combination
MH  - Gastrointestinal Diseases/chemically induced/economics/pathology
MH  - Humans
MH  - Lactones/adverse effects/economics
MH  - Lansoprazole
MH  - Naproxen/adverse effects/economics
MH  - Omeprazole/adverse effects/*analogs & derivatives/economics
MH  - Proton Pump Inhibitors
MH  - Pyrazoles/adverse effects/economics
MH  - Rheumatology/*economics
MH  - Sulfonamides/adverse effects/economics
MH  - Sulfones/adverse effects/economics
RF  - 73
EDAT- 2005/04/09 09:00
MHDA- 2005/05/06 09:00
CRDT- 2005/04/09 09:00
PHST- 2005/04/09 09:00 [pubmed]
PHST- 2005/05/06 09:00 [medline]
PHST- 2005/04/09 09:00 [entrez]
AID - 10.1002/art.21065 [doi]
PST - ppublish
SO  - Arthritis Rheum. 2005 Apr 15;53(2):185-97. doi: 10.1002/art.21065.