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依托考昔与非选择性非甾体抗炎药治疗英国骨关节炎和类风湿关节炎患者的经济学评价

Economic evaluation of etoricoxib versus non-selective NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis patients in the UK.

作者信息

Moore Andrew, Phillips Ceri, Hunsche Elke, Pellissier James, Crespi Simone

机构信息

Pain Research, The Churchill, Headington, Oxford, UK.

出版信息

Pharmacoeconomics. 2004;22(10):643-60. doi: 10.2165/00019053-200422100-00003.

Abstract

INTRODUCTION

The objective of this study was to evaluate the potential economic implications of using etoricoxib versus non-selective NSAID alternatives in the treatment of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) in the UK.

STUDY DESIGN

Decision-analytical modelling was used to calculate the expected costs and consequences of the use of etoricoxib compared with non-selective NSAIDs alone, NSAIDs plus proton pump inhibitors (PPIs), NSAIDs plus histamine H2 receptor antagonists and NSAIDs plus misoprostol over a continuous treatment period of 1 year.

METHODS

The model considered direct medical costs from the perspective of the UK National Health Service (NHS) and used data from phase IIb and III clinical trials of etoricoxib to determine probabilities of gastrointestinal (GI) events. Model outcomes were defined as resource-consuming GI-related events, including clinically evident gastroduodenal perforations, symptomatic gastroduodenal ulcers, or upper GI bleeding (collectively, PUBs ['perforation, ulcers and/or bleeding']). Resource utilisation and costs (2002 values) for the treatment of OA and RA as well as GI events were based on published literature and information available from UK-specific sources.

MAIN OUTCOME MEASURES AND RESULTS

The model suggests that etoricoxib is cost saving compared with non-selective NSAIDs plus PPIs or non-selective NSAIDs plus misoprostol. The model also suggests that etoricoxib is cost effective in terms of the incremental cost per QALY gained for non-selective NSAIDs alone (pound 19,766) and for non-selective NSAIDs plus H2 antagonists (pound 9350). The incremental cost of etoricoxib per PUB avoided was pound 12,446 versus non-selective NSAIDs alone and pound 6438 versus NSAIDs co-prescribed with H2 antagonists. For patients without the presence of specific GI risk factors (history of GI event, corticosteroid use or disability), etoricoxib may be cost effective for patients over age 56 years, assuming a cost-effectiveness threshold of pound 30,000 per QALY gained. Etoricoxib may also be cost effective in patients of all ages who had at least one specific GI risk factor.

CONCLUSIONS

The model suggests, with its underlying assumptions and data, that etoricoxib is a cost-effective alternative to therapeutic regimens involving non-selective NSAIDs for OA or RA, from the UK NHS perspective. Etoricoxib may be cost saving and dominant over non-selective NSAIDs used together with a PPI or misoprostol. When compared with non-selective NSAIDs alone or non-selective NSAIDs co-prescribed with H2 antagonists, the incremental cost per QALY gained with use of etoricoxib was within the generally accepted threshold for cost effectiveness (less than pound 30,000 per QALY gained).

摘要

引言

本研究的目的是评估在英国,使用依托考昔而非非选择性非甾体抗炎药(NSAID)治疗骨关节炎(OA)或类风湿关节炎(RA)患者可能产生的经济影响。

研究设计

采用决策分析模型,计算在连续1年的治疗期内,与单独使用非选择性NSAID、NSAID加质子泵抑制剂(PPI)、NSAID加组胺H2受体拮抗剂以及NSAID加米索前列醇相比,使用依托考昔的预期成本和后果。

方法

该模型从英国国家医疗服务体系(NHS)的角度考虑直接医疗成本,并使用依托考昔IIb期和III期临床试验的数据来确定胃肠道(GI)事件的发生概率。模型结果定义为消耗资源的GI相关事件,包括临床上明显的胃十二指肠穿孔、有症状的胃十二指肠溃疡或上消化道出血(统称为PUBs ['穿孔、溃疡和/或出血'])。OA和RA以及GI事件治疗的资源利用和成本(2002年数值)基于已发表的文献和英国特定来源的可用信息。

主要结局指标与结果

该模型表明,与非选择性NSAID加PPI或非选择性NSAID加米索前列醇相比,依托考昔可节省成本。该模型还表明,就每获得一个质量调整生命年(QALY)的增量成本而言,依托考昔与单独使用非选择性NSAID(19,766英镑)以及非选择性NSAID加H2拮抗剂(9350英镑)相比具有成本效益。与单独使用非选择性NSAID相比,依托考昔每避免一次PUB的增量成本为12,446英镑,与与H2拮抗剂联合使用的NSAID相比为6438英镑。对于没有特定GI危险因素(GI事件史、使用皮质类固醇或残疾)的患者,假设每获得一个QALY的成本效益阈值为30,000英镑,依托考昔对于56岁以上的患者可能具有成本效益。依托考昔对于所有至少有一个特定GI危险因素的患者也可能具有成本效益。

结论

该模型基于其基本假设和数据表明,从英国NHS的角度来看,依托考昔是OA或RA治疗中涉及非选择性NSAID的治疗方案的一种具有成本效益的替代方案。依托考昔可能节省成本,并且优于与PPI或米索前列醇联合使用的非选择性NSAID。与单独使用非选择性NSAID或与H2拮抗剂联合使用的非选择性NSAID相比,使用依托考昔每获得一个QALY的增量成本在普遍接受的成本效益阈值范围内(每获得一个QALY低于30,000英镑)。

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