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Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis
Objective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) as part of a comprehensive management programme, but their use can be associated with side‐effects. Low dose corticosteroid (
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| Published in: | British journal of rheumatology 2003-01, Vol.42 (1), p.46-53 |
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| container_end_page | 53 |
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| container_start_page | 46 |
| container_title | British journal of rheumatology |
| container_volume | 42 |
| creator | Bae, S.‐C. Corzillius, M. Kuntz, K. M. Liang, M. H. |
| description | Objective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) as part of a comprehensive management programme, but their use can be associated with side‐effects. Low dose corticosteroid ( |
| doi_str_mv | 10.1093/rheumatology/keg029 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_195658040</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>332917051</sourcerecordid><originalsourceid>FETCH-LOGICAL-c466t-6f447f9d7b96999855dda2679ed1578090529a215209454c2c5c3217b115bf4b3</originalsourceid><addsrcrecordid>eNpNkUtuFDEQhlsIRB5wAiRkIbFs4ne3lzCCDCJSBAIxYmO5_Zhx0t2e2O7A7DgCp-FAnASPpklYuVT_91eV9VfVMwRfISjIWdzYaVA59GG9O7u2a4jFg-oYUY5rSAh-eFdjelSdpHQFIWSItI-rI4QZFBzh4-r3IqT85-cv65zV2d_a0aYEggN9-A5MSBboELPXhbIxeJPArY1pSmAMY7HNXdUDNWZfGn50vRr2Z8UdMHFap6IYsLhcFRGDtLXaO6-BHze-84VKpQR5Y8vCcV2YMnAAOVqVBzvm_SX__ukNUDFvos8-PakeOdUn-3R-T6sv795-Xizri8vz94vXF7WmnOeaO0obJ0zTCS6EaBkzRmHeCGsQa1ooIMNCYcQwFJRRjTXTBKOmQ4h1jnbktHpxmLuN4WayKcurMMWxrJRIMM5aSGGByAHSMaQUrZPb6AcVdxJBuY9K_h-VPERVXM_n0VM3WHPvmbMpwMsZUEmr3kU1ap_uOUp5izkvXH3gfEnjx52u4rXkDWmYXK6-ya8fyfLD6s0n2ZC_yJW5tA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>195658040</pqid></control><display><type>article</type><title>Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis</title><source>Oxford University Press Journals</source><source>Alma/SFX Local Collection</source><creator>Bae, S.‐C. ; Corzillius, M. ; Kuntz, K. M. ; Liang, M. H.</creator><creatorcontrib>Bae, S.‐C. ; Corzillius, M. ; Kuntz, K. M. ; Liang, M. H.</creatorcontrib><description>Objective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) as part of a comprehensive management programme, but their use can be associated with side‐effects. Low dose corticosteroid (<10 mg/day prednisone) in the treatment of RA is controversial. Although it is effective and possibly disease modifying, concerns exist about potential adverse events. We assessed costs and health effects of corticosteroids compared with NSAIDs and cyclo‐oxgenase‐2 (COX‐2) inhibitors. Methods. Markov (state transition) models were used to simulate a cohort of RA patients taking disease‐modifying antirheumatic drugs and either corticosteroids or NSAIDs. The regimens were assumed to be equally effective for the control of RA. Data on incidence, costs and consequences of adverse events from corticosteroids and from NSAIDs were taken from the literature. Costs were measured in 1999 US dollars; health effects expressed as quality‐adjusted life years (QALYs). Sensitivity analyses were performed including best‐case scenarios (0.5× adverse event rate) and worst‐case scenarios (1.5× adverse event rate). Results. In the base‐case analysis corticosteroids were superior to NSAIDs. The sensitivity analyses of adverse event rate, using best‐case and worst‐case scenarios, and age showed that the results were sensitive to each combination of adverse event rate and age. In contrast, the sensitivity analyses of costs and utilities were robust. Using misoprostol or omeprazole prophylaxis with NSAIDs would make corticosteroids cost‐effective. Compared with NSAIDs with COX‐2 specific inhibition, corticosteroids were still cost‐effective. Conclusion. Corticosteroids are more cost‐effective than NSAIDs and COX‐2 inhibitors in the long‐term treatment of RA.</description><identifier>ISSN: 1462-0324</identifier><identifier>ISSN: 1460-2172</identifier><identifier>EISSN: 1462-0332</identifier><identifier>EISSN: 1460-2172</identifier><identifier>DOI: 10.1093/rheumatology/keg029</identifier><identifier>PMID: 12509612</identifier><identifier>CODEN: BJRHDF</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Age Factors ; Anti-Inflammatory Agents, Non-Steroidal - adverse effects ; Anti-Inflammatory Agents, Non-Steroidal - economics ; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use ; Anti-Ulcer Agents - therapeutic use ; Arthritis, Rheumatoid - drug therapy ; Biological and medical sciences ; Bones, joints and connective tissue. Antiinflammatory agents ; Cohort Studies ; Cost-Benefit Analysis ; Cost‐effectiveness ; COX‐2 inhibitor ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Cyclooxygenase Inhibitors - adverse effects ; Cyclooxygenase Inhibitors - economics ; Cyclooxygenase Inhibitors - therapeutic use ; Drug Costs ; Female ; Glucocorticoids - adverse effects ; Glucocorticoids - economics ; Glucocorticoids - therapeutic use ; Humans ; Inflammatory arthritis ; Isoenzymes - antagonists & inhibitors ; Low dose corticosteroid ; Male ; Markov Chains ; Medical sciences ; Membrane Proteins ; Middle Aged ; Non‐steroidal anti‐inflammatory drug (NSAID) ; Pharmacology. Drug treatments ; Prednisolone - adverse effects ; Prednisolone - economics ; Prednisolone - therapeutic use ; Prostaglandin-Endoperoxide Synthases ; Quality-Adjusted Life Years ; Rheumatoid arthritis</subject><ispartof>British journal of rheumatology, 2003-01, Vol.42 (1), p.46-53</ispartof><rights>2003 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Jan 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-6f447f9d7b96999855dda2679ed1578090529a215209454c2c5c3217b115bf4b3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,4043,27956,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14468266$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12509612$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bae, S.‐C.</creatorcontrib><creatorcontrib>Corzillius, M.</creatorcontrib><creatorcontrib>Kuntz, K. M.</creatorcontrib><creatorcontrib>Liang, M. H.</creatorcontrib><title>Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis</title><title>British journal of rheumatology</title><addtitle>Rheumatology</addtitle><description>Objective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) as part of a comprehensive management programme, but their use can be associated with side‐effects. Low dose corticosteroid (<10 mg/day prednisone) in the treatment of RA is controversial. Although it is effective and possibly disease modifying, concerns exist about potential adverse events. We assessed costs and health effects of corticosteroids compared with NSAIDs and cyclo‐oxgenase‐2 (COX‐2) inhibitors. Methods. Markov (state transition) models were used to simulate a cohort of RA patients taking disease‐modifying antirheumatic drugs and either corticosteroids or NSAIDs. The regimens were assumed to be equally effective for the control of RA. Data on incidence, costs and consequences of adverse events from corticosteroids and from NSAIDs were taken from the literature. Costs were measured in 1999 US dollars; health effects expressed as quality‐adjusted life years (QALYs). Sensitivity analyses were performed including best‐case scenarios (0.5× adverse event rate) and worst‐case scenarios (1.5× adverse event rate). Results. In the base‐case analysis corticosteroids were superior to NSAIDs. The sensitivity analyses of adverse event rate, using best‐case and worst‐case scenarios, and age showed that the results were sensitive to each combination of adverse event rate and age. In contrast, the sensitivity analyses of costs and utilities were robust. Using misoprostol or omeprazole prophylaxis with NSAIDs would make corticosteroids cost‐effective. Compared with NSAIDs with COX‐2 specific inhibition, corticosteroids were still cost‐effective. Conclusion. Corticosteroids are more cost‐effective than NSAIDs and COX‐2 inhibitors in the long‐term treatment of RA.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - economics</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</subject><subject>Anti-Ulcer Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Biological and medical sciences</subject><subject>Bones, joints and connective tissue. Antiinflammatory agents</subject><subject>Cohort Studies</subject><subject>Cost-Benefit Analysis</subject><subject>Cost‐effectiveness</subject><subject>COX‐2 inhibitor</subject><subject>Cyclooxygenase 2</subject><subject>Cyclooxygenase 2 Inhibitors</subject><subject>Cyclooxygenase Inhibitors - adverse effects</subject><subject>Cyclooxygenase Inhibitors - economics</subject><subject>Cyclooxygenase Inhibitors - therapeutic use</subject><subject>Drug Costs</subject><subject>Female</subject><subject>Glucocorticoids - adverse effects</subject><subject>Glucocorticoids - economics</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Humans</subject><subject>Inflammatory arthritis</subject><subject>Isoenzymes - antagonists & inhibitors</subject><subject>Low dose corticosteroid</subject><subject>Male</subject><subject>Markov Chains</subject><subject>Medical sciences</subject><subject>Membrane Proteins</subject><subject>Middle Aged</subject><subject>Non‐steroidal anti‐inflammatory drug (NSAID)</subject><subject>Pharmacology. Drug treatments</subject><subject>Prednisolone - adverse effects</subject><subject>Prednisolone - economics</subject><subject>Prednisolone - therapeutic use</subject><subject>Prostaglandin-Endoperoxide Synthases</subject><subject>Quality-Adjusted Life Years</subject><subject>Rheumatoid arthritis</subject><issn>1462-0324</issn><issn>1460-2172</issn><issn>1462-0332</issn><issn>1460-2172</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNpNkUtuFDEQhlsIRB5wAiRkIbFs4ne3lzCCDCJSBAIxYmO5_Zhx0t2e2O7A7DgCp-FAnASPpklYuVT_91eV9VfVMwRfISjIWdzYaVA59GG9O7u2a4jFg-oYUY5rSAh-eFdjelSdpHQFIWSItI-rI4QZFBzh4-r3IqT85-cv65zV2d_a0aYEggN9-A5MSBboELPXhbIxeJPArY1pSmAMY7HNXdUDNWZfGn50vRr2Z8UdMHFap6IYsLhcFRGDtLXaO6-BHze-84VKpQR5Y8vCcV2YMnAAOVqVBzvm_SX__ukNUDFvos8-PakeOdUn-3R-T6sv795-Xizri8vz94vXF7WmnOeaO0obJ0zTCS6EaBkzRmHeCGsQa1ooIMNCYcQwFJRRjTXTBKOmQ4h1jnbktHpxmLuN4WayKcurMMWxrJRIMM5aSGGByAHSMaQUrZPb6AcVdxJBuY9K_h-VPERVXM_n0VM3WHPvmbMpwMsZUEmr3kU1ap_uOUp5izkvXH3gfEnjx52u4rXkDWmYXK6-ya8fyfLD6s0n2ZC_yJW5tA</recordid><startdate>200301</startdate><enddate>200301</enddate><creator>Bae, S.‐C.</creator><creator>Corzillius, M.</creator><creator>Kuntz, K. M.</creator><creator>Liang, M. H.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>200301</creationdate><title>Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis</title><author>Bae, S.‐C. ; Corzillius, M. ; Kuntz, K. M. ; Liang, M. H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-6f447f9d7b96999855dda2679ed1578090529a215209454c2c5c3217b115bf4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - economics</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - therapeutic use</topic><topic>Anti-Ulcer Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Biological and medical sciences</topic><topic>Bones, joints and connective tissue. Antiinflammatory agents</topic><topic>Cohort Studies</topic><topic>Cost-Benefit Analysis</topic><topic>Cost‐effectiveness</topic><topic>COX‐2 inhibitor</topic><topic>Cyclooxygenase 2</topic><topic>Cyclooxygenase 2 Inhibitors</topic><topic>Cyclooxygenase Inhibitors - adverse effects</topic><topic>Cyclooxygenase Inhibitors - economics</topic><topic>Cyclooxygenase Inhibitors - therapeutic use</topic><topic>Drug Costs</topic><topic>Female</topic><topic>Glucocorticoids - adverse effects</topic><topic>Glucocorticoids - economics</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Humans</topic><topic>Inflammatory arthritis</topic><topic>Isoenzymes - antagonists & inhibitors</topic><topic>Low dose corticosteroid</topic><topic>Male</topic><topic>Markov Chains</topic><topic>Medical sciences</topic><topic>Membrane Proteins</topic><topic>Middle Aged</topic><topic>Non‐steroidal anti‐inflammatory drug (NSAID)</topic><topic>Pharmacology. Drug treatments</topic><topic>Prednisolone - adverse effects</topic><topic>Prednisolone - economics</topic><topic>Prednisolone - therapeutic use</topic><topic>Prostaglandin-Endoperoxide Synthases</topic><topic>Quality-Adjusted Life Years</topic><topic>Rheumatoid arthritis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bae, S.‐C.</creatorcontrib><creatorcontrib>Corzillius, M.</creatorcontrib><creatorcontrib>Kuntz, K. M.</creatorcontrib><creatorcontrib>Liang, M. H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>British journal of rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bae, S.‐C.</au><au>Corzillius, M.</au><au>Kuntz, K. M.</au><au>Liang, M. H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis</atitle><jtitle>British journal of rheumatology</jtitle><addtitle>Rheumatology</addtitle><date>2003-01</date><risdate>2003</risdate><volume>42</volume><issue>1</issue><spage>46</spage><epage>53</epage><pages>46-53</pages><issn>1462-0324</issn><issn>1460-2172</issn><eissn>1462-0332</eissn><eissn>1460-2172</eissn><coden>BJRHDF</coden><notes>istex:016A52047F3A8572BD1F60B7EBC173F9F5FCDFF5</notes><notes>local:420046</notes><notes>ark:/67375/HXZ-WQ3HKXBR-7</notes><notes>PII:1460-2172</notes><abstract>Objective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) are used in nearly every patient with rheumatoid arthritis (RA) as part of a comprehensive management programme, but their use can be associated with side‐effects. Low dose corticosteroid (<10 mg/day prednisone) in the treatment of RA is controversial. Although it is effective and possibly disease modifying, concerns exist about potential adverse events. We assessed costs and health effects of corticosteroids compared with NSAIDs and cyclo‐oxgenase‐2 (COX‐2) inhibitors. Methods. Markov (state transition) models were used to simulate a cohort of RA patients taking disease‐modifying antirheumatic drugs and either corticosteroids or NSAIDs. The regimens were assumed to be equally effective for the control of RA. Data on incidence, costs and consequences of adverse events from corticosteroids and from NSAIDs were taken from the literature. Costs were measured in 1999 US dollars; health effects expressed as quality‐adjusted life years (QALYs). Sensitivity analyses were performed including best‐case scenarios (0.5× adverse event rate) and worst‐case scenarios (1.5× adverse event rate). Results. In the base‐case analysis corticosteroids were superior to NSAIDs. The sensitivity analyses of adverse event rate, using best‐case and worst‐case scenarios, and age showed that the results were sensitive to each combination of adverse event rate and age. In contrast, the sensitivity analyses of costs and utilities were robust. Using misoprostol or omeprazole prophylaxis with NSAIDs would make corticosteroids cost‐effective. Compared with NSAIDs with COX‐2 specific inhibition, corticosteroids were still cost‐effective. Conclusion. Corticosteroids are more cost‐effective than NSAIDs and COX‐2 inhibitors in the long‐term treatment of RA.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>12509612</pmid><doi>10.1093/rheumatology/keg029</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals; Alma/SFX Local Collection |
| subjects | Adult Age Factors Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - economics Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Anti-Ulcer Agents - therapeutic use Arthritis, Rheumatoid - drug therapy Biological and medical sciences Bones, joints and connective tissue. Antiinflammatory agents Cohort Studies Cost-Benefit Analysis Cost‐effectiveness COX‐2 inhibitor Cyclooxygenase 2 Cyclooxygenase 2 Inhibitors Cyclooxygenase Inhibitors - adverse effects Cyclooxygenase Inhibitors - economics Cyclooxygenase Inhibitors - therapeutic use Drug Costs Female Glucocorticoids - adverse effects Glucocorticoids - economics Glucocorticoids - therapeutic use Humans Inflammatory arthritis Isoenzymes - antagonists & inhibitors Low dose corticosteroid Male Markov Chains Medical sciences Membrane Proteins Middle Aged Non‐steroidal anti‐inflammatory drug (NSAID) Pharmacology. Drug treatments Prednisolone - adverse effects Prednisolone - economics Prednisolone - therapeutic use Prostaglandin-Endoperoxide Synthases Quality-Adjusted Life Years Rheumatoid arthritis |
| title | Cost‐effectiveness of low dose corticosteroids versus non‐steroidal anti‐inflammatory drugs and COX‐2 specific inhibitors in the long‐term treatment of rheumatoid arthritis |
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