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Osteoarthritis Cartilage. 2018 May;26(5):641-650. doi: 10.1016/j.joca.2018.02.898. Epub 2018 Mar 2.

Cost-effectiveness of generic celecoxib in knee osteoarthritis for average-risk patients: a model-based evaluation.

Author information

1
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Boston University School of Public Health, Boston, MA, USA. Electronic address: elosina@bwh.harvard.edu.
2
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: ilanausiskin@gmail.com.
3
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: savannah.reid.smith@gmail.com.
4
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: jsullivan76@bwh.harvard.edu.
5
Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Research Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: ksmith81@bwh.harvard.edu.
6
Institute of Bone and Joint Research, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia. Electronic address: David.Hunter@sydney.edu.au.
7
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA. Electronic address: messier@wfu.edu.
8
Yale School of Public Health, Yale School of Management, New Haven, CT, USA. Electronic address: david.paltiel@yale.edu.
9
Division of Rheumatology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: jnkatz@bwh.harvard.edu.

Abstract

OBJECTIVE:

The cost-effectiveness of the recently-introduced generic celecoxib in knee OA has not been examined.

METHOD:

We used the Osteoarthritis Policy (OAPol) Model, a validated computer simulation of knee OA, to evaluate long-term clinical outcomes, costs, and cost-effectiveness of generic celecoxib in persons with knee OA. We examined eight treatment strategies consisting of generic celecoxib, over-the-counter (OTC) naproxen, or prescription naproxen, with or without prescription or OTC proton-pump-inhibitors (PPIs) to reduce gastrointestinal (GI) toxicity. In the base case, we assumed that annual cost was $130 for OTC naproxen, $360 for prescription naproxen, and $880 for generic celecoxib. We considered a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) and discounted costs and benefits at 3% annually. In sensitivity analyses we varied celecoxib toxicity, discontinuation, cost, and pain level.

RESULTS:

In the base case analysis of the high pain cohort (WOMAC 50), celecoxib had an incremental cost-effectiveness ratio (ICER) of $284,630/QALY compared with OTC naproxen. Only under highly favorable cost, toxicity, and discontinuation assumptions (e.g., annual cost below $360, combined with a reduction in the cardiovascular (CV) event rates below baseline values) was celecoxib likely to be cost-effective. Celecoxib might also be cost-effective at an annual cost of $600 if CV toxicity were eliminated completely. In subjects with moderate pain (WOMAC 30), at the base case CV event rate of 0.2%, generic celecoxib was only cost-effective at the lowest plausible cost ($190).

CONCLUSION:

In knee OA patients with no comorbidities, generic celecoxib is not cost-effective at its current price.

KEYWORDS:

Celecoxib; Cost-effectiveness; NSAIDs; Osteoarthritis

PMID:
29481917
DOI:
10.1016/j.joca.2018.02.898

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