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Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors.

Contreras-Hernández I, Mould-Quevedo JF, Torres-González R, Goycochea-Robles MV, Pacheco-Domínguez RL, Sánchez-García S, Mejía-Aranguré JM, Garduño-Espinosa J - Cost Eff Resour Alloc (2008)

Bottom Line: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib.According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option.In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unidad de Investigación en Economía de la Salud, Instituto Mexicano del Seguro Social, Mexico, D,F, Mexico.

ABSTRACT

Background: Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS).

Methods: A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period.

Results: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.

Conclusion: From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

No MeSH data available.


Related in: MedlinePlus

Decision tree. Reproduction of clinical reality observed in patients with osteoarthritis (OA) receiving one of the alternatives to be compared for the treatment of joint pain, found in each of the three health care levels at the Instituto Mexicano del Seguro Social, identifying the probability to control pain, as well as the development of gastrointestinal, renal and/or cardiovascular complications. NSAIDs, nonsteroidal anti-inflammatory drugs; GI, gastrointestinal.
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Figure 1: Decision tree. Reproduction of clinical reality observed in patients with osteoarthritis (OA) receiving one of the alternatives to be compared for the treatment of joint pain, found in each of the three health care levels at the Instituto Mexicano del Seguro Social, identifying the probability to control pain, as well as the development of gastrointestinal, renal and/or cardiovascular complications. NSAIDs, nonsteroidal anti-inflammatory drugs; GI, gastrointestinal.

Mentions: The model starts with the description of a base case of an adult patient diagnosed with OA of the knee and/or hip and the need for pharmacological treatment for severe joint pain. Three decision nodes corresponding to the three alternatives (acetaminofen, nonselective NSAIDs or celecoxib) are generated. The first probabilistic node corresponding to pain improvement or no pain improvement arises from each of them. The "no improvement" branch corresponds to therapeutic failure and the prescription of one of the two remaining alternatives available is mandatory, with a new generation of branches, pain control or no pain control. From the latter, another branch arises now using the remaining treatment option. The next tree branch, as a consequence of pain improvement, is divided into the presence of adverse effects or no adverse effects. When no adverse events occur, it is converted into a terminal node and is considered a therapeutic success, thus corresponding to the effectiveness measure. The next probabilistic node arises from the occurrence of adverse events towards the probability for the development of gastric symptoms, GI bleeding, renal toxicity, and cardiovascular events during a 6-month period of continuous treatment with these drugs. A schematic flow chart is shown in Figure 1.


Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors.

Contreras-Hernández I, Mould-Quevedo JF, Torres-González R, Goycochea-Robles MV, Pacheco-Domínguez RL, Sánchez-García S, Mejía-Aranguré JM, Garduño-Espinosa J - Cost Eff Resour Alloc (2008)

Decision tree. Reproduction of clinical reality observed in patients with osteoarthritis (OA) receiving one of the alternatives to be compared for the treatment of joint pain, found in each of the three health care levels at the Instituto Mexicano del Seguro Social, identifying the probability to control pain, as well as the development of gastrointestinal, renal and/or cardiovascular complications. NSAIDs, nonsteroidal anti-inflammatory drugs; GI, gastrointestinal.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626578&req=5

Figure 1: Decision tree. Reproduction of clinical reality observed in patients with osteoarthritis (OA) receiving one of the alternatives to be compared for the treatment of joint pain, found in each of the three health care levels at the Instituto Mexicano del Seguro Social, identifying the probability to control pain, as well as the development of gastrointestinal, renal and/or cardiovascular complications. NSAIDs, nonsteroidal anti-inflammatory drugs; GI, gastrointestinal.
Mentions: The model starts with the description of a base case of an adult patient diagnosed with OA of the knee and/or hip and the need for pharmacological treatment for severe joint pain. Three decision nodes corresponding to the three alternatives (acetaminofen, nonselective NSAIDs or celecoxib) are generated. The first probabilistic node corresponding to pain improvement or no pain improvement arises from each of them. The "no improvement" branch corresponds to therapeutic failure and the prescription of one of the two remaining alternatives available is mandatory, with a new generation of branches, pain control or no pain control. From the latter, another branch arises now using the remaining treatment option. The next tree branch, as a consequence of pain improvement, is divided into the presence of adverse effects or no adverse effects. When no adverse events occur, it is converted into a terminal node and is considered a therapeutic success, thus corresponding to the effectiveness measure. The next probabilistic node arises from the occurrence of adverse events towards the probability for the development of gastric symptoms, GI bleeding, renal toxicity, and cardiovascular events during a 6-month period of continuous treatment with these drugs. A schematic flow chart is shown in Figure 1.

Bottom Line: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib.According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option.In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unidad de Investigación en Economía de la Salud, Instituto Mexicano del Seguro Social, Mexico, D,F, Mexico.

ABSTRACT

Background: Osteoarthritis (OA) is one of the main causes of disability worldwide, especially in persons >55 years of age. Currently, controversy remains about the best therapeutic alternative for this disease when evaluated from a cost-effectiveness viewpoint. For Social Security Institutions in developing countries, it is very important to assess what drugs may decrease the subsequent use of medical care resources, considering their adverse events that are known to have a significant increase in medical care costs of patients with OA. Three treatment alternatives were compared: celecoxib (200 mg twice daily), non-selective NSAIDs (naproxen, 500 mg twice daily; diclofenac, 100 mg twice daily; and piroxicam, 20 mg/day) and acetaminophen, 1000 mg twice daily. The aim of this study was to identify the most cost-effective first-choice pharmacological treatment for the control of joint pain secondary to OA in patients treated at the Instituto Mexicano del Seguro Social (IMSS).

Methods: A cost-effectiveness assessment was carried out. A systematic review of the literature was performed to obtain transition probabilities. In order to evaluate analysis robustness, one-way and probabilistic sensitivity analyses were conducted. Estimations were done for a 6-month period.

Results: Treatment demonstrating the best cost-effectiveness results [lowest cost-effectiveness ratio $17.5 pesos/patient ($1.75 USD)] was celecoxib. According to the one-way sensitivity analysis, celecoxib would need to markedly decrease its effectiveness in order for it to not be the optimal treatment option. In the probabilistic analysis, both in the construction of the acceptability curves and in the estimation of net economic benefits, the most cost-effective option was celecoxib.

Conclusion: From a Mexican institutional perspective and probably in other Social Security Institutions in similar developing countries, the most cost-effective option for treatment of knee and/or hip OA would be celecoxib.

No MeSH data available.


Related in: MedlinePlus