PAM9: COST COMPARISON OF TREATING RHEUMATOID ARTHRITIS PATIENTS WITH COX-2 INHIBITORS OR NSAIDS IN A MANAGED CARE POPULATION

Abstract

OBJECTIVE: To compare rheumatoid arthritis (RA) treatment charges with a cyclooxygenase-2 specific inhibitor (COX-2) versus a non-steroidal anti-inflammatory drug (NSAID) therapies in a managed care population. METHODS: Patients with a diagnosis of RA between January 1 and June 30, 1999 who had prescriptions for COX-2s or NSAIDs were selected from the PharMetrics Integrated Outcomes Database. Patients were excluded if they had osteoarthritis or did not have 6 months of continuous enrollment following the first (index) COX-2 or NSAID pharmacy claim. COX-2 and NSAID-treated groups were compared on their demographics, comorbidities, and total RA-specific charges during the 6 month follow-up period RESULTS: A total of 5,261 patients met the patient selection criteria, including 668 who received COX-2 and 4,593 who received NSAID. The COX-2 group was older (53.7 versus 49.6 years, p < 0.0001) on average and more likely to have at least one comorbidity (46.0% vs. 31.9%, p < 0.001) compared to the NSAID group. They also had higher RA-related pharmacy ($914 versus $636) and medical charges ($611 versus $566). Total mean charges for the COX-2 cohort were $323 higher (p = 0.019) than the NSAID cohort. CONCLUSION: In this initial cost comparison between COX-2s and NSAIDs, the mean charge for a 6-month period with COX-2s was 27% higher than with NSAIDs, mainly due to higher pharmacy charges. Longer-term studies are required to examine whether the higher acquisition costs of COX-2 are offset by savings in the costs of treating gastrotoxicity.