https://orcid.org/0000-0001-9462-9261
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Abstract
Objective
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.
Methods
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).
Results
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.
Conclusion
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.
Clinicaltrials.gov Registration Number
NCT00346216.
Disclosure
Earlier versions of this analysis were presented at International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2020, USA as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” (Ahmed OH, Chirikov V, Walker C, Stephens JM, Schepman P, Chambers R, Bakir M, Poorman G, Haider S. Cost-Effectiveness of Celecoxib Versus Ibuprofen and Naproxen In Patients With Osteoarthritis In United Arab Emirates And Saudi Arabia Based On Results From The Precision Trial. Value in Health. 2020 May 1;23:S130. https://www.valueinhealthjournal.com/article/S1098-3015(20)30488-5/abstract).
V Chirikov and J Stephens are employees of Pharmerit International - an OPEN Health Company. P Schepman and R Chambers are employees of Pfizer and may own stock options. M Bakir is an employee of Upjohn Export B.V. and may own sotck options. At the time of the study conduct, C Walker, G Poorman and S Haider were employees of Pfizer. Pharmerit International - an OPEN Health Company received funding from Pfizer to conduct the study. C Walker is now an employee of Viatris and may own stock options. The authors report no other conflicts of interest in this work.