Objectives Rofecoxib (VIOXX) patients were shown in Phase III clinical trials to have significantly fewer clinically significant gastrointestinal (GI) adverse events than those who received non-selective NSAIDs for the treatment of osteoarthritis (OA). We evaluated the clinical and economic consequences of rofecoxib prescription in each of the ten Canadian provinces for patients over 65 who were assumed to have failed acetaminophen therapy.
Methods A cost-effectiveness analysis was conducted comparing rofecoxib to non-selective NSAIDs with respect to their gastrointestinal effects on patients with OA. A decision analytic model, with a time horizon of one year, was constructed focussing on the event rates from a pooled analysis of 8 Phase IIb/III clinical trials. The number of perforations, ulcers and bleeds (PUBs) in each strategy was used as the primary measure of effectiveness. Province-specific inputs were incorporated to determine the relative impact of provincial differences in reimbursement policies, medication mix, prescription length, and dispensing fees on the economic results.
Results In six of the ten Canadian provinces, the replacement of traditional NSAIDs with rofecoxib was associated with fewer PUBs, but at a slightly higher annual cost per patient to the provincial governments (range: $21.37 – $133.42). In Alberta, Manitoba, Quebec and Newfoundland the use of rofecoxib was associated with an annual cost saving in addition to the clinical benefit of fewer PUBs. The variation in the model results across provinces was primarily due to the variation in average NSAID and GPA costs across the provinces. As drug choices differ between the provinces, the average daily cost of an NSAID was seen to vary between $0.49 in Nova Scotia to $1.24 in Newfoundland. Likewise, the average daily cost of a GPA ranged from $0.72 in New Brunswick to $2.11 in Alberta.
Conclusion Rofecoxib may represent a cost-effective alternative to non-selective NSAIDs for the treatment of OA in Canada, despite provincial differences in reimbursement policies and medication mix which generate varying burdens on payers and patients.
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