Journal of Medical Economics

Health economic comparisons of rofecoxib versus conventional nonsteroidal antiinflammatory drugs for osteoarthritis in the United Kingdom

R Andrew Moore DSc 1, Ceri J Phillips PhD 2,
James M Pellissier PhD 3 and Sheldon X Kong PhD 4

1 Pain Research, Nuffield Department of Anaesthetics, University of Oxford, The Churchill, Oxford OX3 7LJ, UK
2 School of Health Science, University of Wales, Swansea, Singleton Park, Swansea SA2 8PP, UK
3 Clinical and Health Economic Statistics, Merck Research Laboratories, 40W645 Aberdeen Lane, St Charles, IL 60175, USA
4 Outcomes Research, Merck & Co., Inc. One Merck Drive, Whitehouse Station, NJ 08889, USA

Key words: osteoarthritis, NSAID, rofecoxib, cost comparison

Summary
Conventional NSAIDs cause major gastrointestinal complications and minor symptoms. Most publications on the economic implications of NSAID gastropathy have examined ulceration rates with endoscopy, adjusted for ulcers that are "silent," i.e. never require clinical treatment. Silent ulcer rates used range from 40% to 85%. Decision analytic modeling was done to examine the economic implications of switching all OA patients currently treated with conventional NSAIDs to rofecoxib, from the perspective of the National Health Service. continued Analysis 1 was based on investigator observed perforations, symptomatic ulcers, and bleeds (PUBs). Analyses 2 and 3 were based on endoscopic ulcers with adjustments for silent ulcers of 85% and 40%, respectively. Analysis 1 showed that switching patients currently treated with conventional NSAIDs to rofecoxib would cost the NHS £0.32 extra per patient per day with cost per year of life saved estimated at £15,647, a figure within accepted benchmarks for cost-effectiveness of medical interventions. In Analyses 2 and 3, switching from conventional NSAIDs to rofecoxib would be cost-saving to the NHS.