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To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes.
The nonsteroidal
anti-inflammatory drugs like naproxen and ibuprofen and opioids like celecoxib
are used here for the older knee osteoarthritis patients. Ibuprofen was found
to be most effective and cost productive for this diseased condition.
To evaluate
long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or
tramadol for OA patients with cardiovascular disease (CVD) and diabetes.
We used the
Osteoarthritis Policy Model to examine treatment with these analgesics after
standard of care (SOC) – acetaminophen and corticosteroid injections – failed to
control pain. NSAID regimens were evaluated with and without proton pump
inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where
available. Estimates of treatment efficacy (pain reduction, occurring in ∼57% of
patients on all regimens) and toxicity (major cardiac or gastrointestinal
toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with
tramadol) were derived from published literature. Annual costs came from Red
Book Online®. Outcomes were discounted at 3%/year and included costs,
quality-adjusted life expectancy, and incremental cost-effectiveness ratios
(ICERs). Key input parameters were varied in sensitivity analyses.
Adding ibuprofen
to SOC was cost saving, increasing QALYs by 0.07 while decreasing cost by $800.
Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased
costs by $300, resulting in an ICER of $54,800/QALY. Using prescription
naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of
prescription naproxen with prescription PPIs resulted in an ICER of
$252,300/QALY. Regimens including tramadol or celecoxib cost more but added
fewer QALYs and thus were dominated by several of the naproxen-containing
regimens.
In patients with
multiple comorbidities, naproxen- and ibuprofen-containing regimens are more
effective and cost-effective in managing OA pain than opioids, celecoxib or
SOC.
Osteoarthritis Cartilage. 2016 Mar;24(3):409-18
Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities
J.N. Katz et al.
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