Chirikov Viktor V, Walker Chris, Stephens Jennifer M, Schepman Patricia, Chambers Richard, Bakir Mahmoud, Poorman Gregory W, Haider Seema, Farghaly Mohammed
OPEN Health, Bethesda, MD, USA.
Global Medical Affairs, Viatris, Tadworth, UK.
Clinicoecon Outcomes Res. 2021 May 19;13:409-420. doi: 10.2147/CEOR.S280556. eCollection 2021.
Data on osteoarthritis patients from the PRECISION trial were used to evaluate the cost-effectiveness of celecoxib (100 mg twice daily) versus ibuprofen (600-800 mg three times daily) and naproxen (375-500 mg twice daily). The perspective was that of the United Arab Emirates (UAE) healthcare system.
Discrete-state Markov model with monthly cycles, 30-month horizon, and 3% discount rate was constructed to assess incremental costs per quality adjusted life year (QALYs) gained from reduced incidence of three safety domains examined in PRECISION: renal, serious gastrointestinal (GI), and major adverse cardiovascular events (MACE). Costs for managing these toxicities were derived from Dubai Administrative Billing Claims (2018). Median monthly drug costs were derived from UAE Ministry of Health and Prevention's published prices ($26.98 celecoxib; $20.25 ibuprofen; $20.50 naproxen). Health utility and excess mortality associated with toxicities were sourced from the literature. The willingness-to-pay thresholds used were 1 and 3 GDP per capita ($40,000-$120,000).
The total average cost per patient was $812.88 for celecoxib, $775.26 for ibuprofen, and $731.17 for naproxen while cost components attributed to toxicities were lowest with celecoxib ($360.26, $438.31, and $388.60, respectively). Patients on celecoxib had more QALYs (1.339), compared with ibuprofen (1.335) and naproxen (1.337), resulting in an incremental cost-effectiveness ratio of $11,502/QALY gained for celecoxib versus ibuprofen and $39,779 for celecoxib versus naproxen. Probabilistic sensitivity analyses demonstrated celecoxib to be 81% cost-effective versus ibuprofen and 50% versus naproxen at $40,000/QALY. The most influential model parameters were MACE relative safety and drug costs.
From UAE third payer perspective, celecoxib is a long-term cost-effective treatment for osteoarthritis patients when compared with ibuprofen, and equally likely as naproxen to be cost-effective. With the expected increasing burden of chronic diseases in the Gulf region, study findings can inform decisions regarding the cost-effective pain management of osteoarthritis in UAE.
NCT00346216.
利用精准试验中骨关节炎患者的数据，评估塞来昔布（每日两次，每次100毫克）与布洛芬（每日三次，每次600 - 800毫克）以及萘普生（每日两次，每次375 - 500毫克）的成本效益。分析视角为阿拉伯联合酋长国（阿联酋）医疗保健系统。
构建具有月度周期、30个月时间范围和3%贴现率的离散状态马尔可夫模型，以评估从精准试验中所考察的三个安全领域（肾脏、严重胃肠道（GI）和主要不良心血管事件（MACE））发病率降低所获得的每质量调整生命年（QALY）的增量成本。管理这些毒性反应的成本来自迪拜行政计费索赔（2018年）。每月药物成本中位数来自阿联酋卫生与预防部公布的价格（塞来昔布26.98美元；布洛芬20.25美元；萘普生20.50美元）。与毒性反应相关的健康效用和超额死亡率来自文献。所使用的支付意愿阈值为1和3倍人均国内生产总值（40,000 - 120,000美元）。
塞来昔布每位患者的总平均成本为812.88美元，布洛芬为775.26美元，萘普生为731.17美元，而归因于毒性反应的成本部分塞来昔布最低（分别为360.26美元、438.31美元和388.60美元）。与布洛芬（1.335）和萘普生（1.337）相比，服用塞来昔布的患者获得更多QALY（1.339），塞来昔布相对于布洛芬的增量成本效益比为每获得1个QALY增加11,502美元，相对于萘普生为39,779美元。概率敏感性分析表明，在每QALY 40,000美元时，塞来昔布相对于布洛芬的成本效益为81%，相对于萘普生为50%。最具影响力的模型参数是MACE相对安全性和药物成本。
从阿联酋第三方支付方的角度来看，与布洛芬相比，塞来昔布是骨关节炎患者的一种长期具有成本效益的治疗方法，并且与萘普生具有同等的成本效益可能性。鉴于海湾地区慢性病负担预计会增加，研究结果可为阿联酋骨关节炎成本效益疼痛管理决策提供参考。
NCT00346216
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