BACKGROUND: Rofecoxib and @entity12698 (coxibs) effectively treat @entity1118 and reduce @entity1066 complications by 50% compared with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). However, their absolute risk reduction is small and the cost-effectiveness of treatment is uncertain. OBJECTIVE: To determine whether the degree of risk reduction in @entity344 by coxibs offsets their increased cost compared with a generic nonselective NSAID. DESIGN: Cost-utility analysis. DATA SOURCES: Systematic review of MEDLINE and published abstracts. TARGET POPULATION: @entity1 with @entity571 or @entity309 who are not taking @entity117 and who require long-term NSAID therapy for moderate to severe @entity625 pain. PERSPECTIVE: Third-party payer. INTERVENTIONS: @entity1623 , 500 mg twice daily, and coxib, once daily. @entity1 intolerant of @entity1623 were switched to a coxib. TIME HORIZON: Lifetime. OUTCOME MEASURES: Incremental cost per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASE ANALYSIS: Using a coxib instead of a nonselective NSAID in average-risk @entity1 cost an incremental 275 809 dollars per year to gain 1 additional QALY. RESULTS OF SENSITIVITY ANALYSIS: The incremental cost per QALY gained decreased to 55 803 dollars when the analysis was limited to the subset of @entity1 with a history of bleeding @entity1066 . The coxib strategy became dominant when the cost of coxibs was reduced by 90% of the current average wholesale price. In probabilistic sensitivity analysis, if a third-party payer was willing to pay 150 000 dollars per QALY gained, then 4.3% of average-risk @entity1 would fall within the budget. CONCLUSIONS: The risk reduction seen with coxibs does not offset their increased costs compared with nonselective NSAIDs in the management of average-risk @entity1 with @entity625 . However, coxibs may provide an acceptable incremental cost-effectiveness ratio in the subgroup of @entity1 with a history of bleeding @entity1066 .

The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of XXXX .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients'] @entity12698 :: ('MESH:C105934', 'Chemical') :: ['celecoxib'] @entity571 :: ('MESH:D010003', 'Disease') :: ['osteoarthritis'] @entity625 :: ('MESH:D001168', 'Disease') :: ['chronic arthritis', 'arthritis'] @entity1066 :: ('MESH:D014456', 'Disease') :: ['ulcer', 'ulcers'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity344 :: ('MESH:D005767', 'Disease') :: ['gastrointestinal complications'] @entity1623 :: ('MESH:D009288', 'Chemical') :: ['naproxen', 'Naproxen'] @entity1118 :: ('MESH:D059350', 'Disease') :: ['chronic arthritis pain'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis']
@entity625 :: (MESH:D001168,Disease) :: ['chronic arthritis']
