How much does an antiinflammatory treatment cost?

Abstract

NSAIDs are among the most popular drugs in the world for their efficacyin controlling pain and acute and chronic inflammation. The efficacyof these therapies is hampered by their safety profile, in particularregarding the gastroenteric tract. The NSAIDs' side effects may heavilyinfluence the health of the single patient and the economy of thehealth systems. The pharmacoeconomic evaluation of antinflammatorytreatment usually considers, in addition to the drug purchase prize,also the shadow costs. This cost is mainly due to the managementand prevention of gastropathy. Coxibs, even if more expensive, maybecome cost-effective for their better gastronteric safety. As amatter of fact, coxib treatment can be considered equivalent to atreatment with NSAID plus PPI. However, the first requirement ofthese drugs, that should control pain, must be the efficacy and notonly safety. In this case the NNT (Number Needed to Treat) is a goodmarker of efficacy. To calculate the real cost we must pay to reachthe target (pain resolution in one patient), we can multiply NNTfor the prize of a specific drug. The total cost will depend on drugprize (the cheaper, the better) and on the efficacy expressed byNNT (the lower, the better). In a recent meta-analysis, the NNT ofseveral antinflammatory drugs has been calculated. When the treatmentcost was adjusted for its efficacy (NNT), the difference in favourof NSAIDs became so little to disappear because of the higher safetyof coxibs (especially of etoricoxiband the possibility to reach antinflammatoryand analgesic doses that are difficult to obtain with NSAIDs. Moreover,if also the cost of gastroprotection is considered, the economicimpact of NSAIDs can be much higher. In conclusion the pharmacoeconomicanalysis of an antinflammatory therapy cannot be based only on safetyissues but also on efficacy evaluation that is the main effect weask to these drugs.