FRIDAY, Dec. 12, 2003 (HealthDayNews) -- A study by one of the nation's largest managers of drug benefits calls into question the cost effectiveness of popular anti-inflammatory drugs such as Vioxx and Celebrex.

Researchers at Express Scripts Inc. in St. Louis used prescription and medical claims data from a large, Midwest preferred provider organization to test a key assumption underlying earlier studies demonstrating the drugs' value. The findings show the newfangled arthritis drugs aren't the cost savers previously thought.

"We question some of those early cost-effectiveness studies," says study author Emily R. Cox, manager of outcomes research at Express Scripts. The study appears in the November issue of the Journal of Managed Care.

Vioxx and Celebrex belong to a newer, more expensive class of anti-inflammatory medications that are known as cox-2 inhibitors. While traditional anti-inflammatories such as aspirin, ibuprofen and naproxen are still prescribed for relieving arthritic pain, cox-2 drugs have been shown to be much easier on the stomach.

Before Vioxx and Celebrex hit the market, doctors sometimes would put patients taking ibuprofen or other traditional nonsteroidal anti-inflammatory drugs (NSAIDs) on stomach-protecting medicines to avoid ulcers, heartburn and other gastrointestinal problems.

Early cost-effectiveness studies assumed cox-2 patients would need less heartburn and ulcer medication, if any at all. It turns out, however, that doctors are prescribing stomach-protecting drugs to cox-2 patients at a marginally higher rate than previously assumed, researchers at Express Scripts found.

When the authors recalculated the cost effectiveness of cox-2 drugs using the rate that doctors actually prescribe so-called gastroprotective agents, cost per year of life saved exceeded $100,000, up from $18,614 in an earlier study.

"We should be willing to pay at least $50,000 to save one year of life," Cox says, citing what she said is considered the economically acceptable threshold. "When it gets to $100,000, then you start to question, 'Would these resources be better spent in other ways?'"

Christopher Loder, a spokesman for Merck & Co., maker of Vioxx, notes the authors themselves concede the results are not the definitive answer to the cost effectiveness of these drugs.

"In our studies, Vioxx significantly reduced the need for gastroprotective medicines," he adds.

In clinical trials of the drug involving 9,000 participants, only 11.2 percent of Vioxx patients were taking medicines for ulcer and heartburn, Loder says. By contrast, 14.5 percent of patients on naproxen were prescribed a gastroprotective agent.

Cox-2 drugs may be cost effective for patients at higher risk of gastrointestinal problems, Cox reasons. In a general population, though, a traditional NSAID is appropriate and cost effective.

More information

To learn more about arthritis pain-relieving options, visit the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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