[Cost-effectiveness analysis of celecoxib versus non-selective non-steroidal anti-inflammatory drug therapy for the treatment of osteoarthritis in Spain: A current perspective]. / Análisis coste-efectividad de celecoxib frente a antiinflamatorios no esteroideos no selectivos en el tratamiento de la artrosis en España: una perspectiva actual.

OBJECTIVE: To assess the cost-effectiveness of celecoxib and non-selective non-steroidal anti-inflammatory drugs for the treatment of osteoarthritis in clinical practice in Spain. METHODS: A decision-tree model using distribution, doses, treatment duration and incidence of GI and CV events observed in the pragmatic PROBE-designed «GI-Reasons¼ trial was used for cost-effectiveness. Effectiveness was expressed in terms of event averted and quality-adjusted life-years (QALY) gained. QALY were calculated based on utility decrement in case of any adverse events reported in GI-Reasons trial. The National Health System perspective in Spain was applied; cost calculations included current prices of drugs plus cost of adverse events occurred. The analysis was expressed as an incremental cost-effectiveness ratio per QALY gained and per event averted. One-way and probabilistic analyses were performed. RESULTS: Compared with non-selective non-steroidal anti-inflammatory drugs, at current prices, celecoxib treatment had higher overall treatment costs €201 and €157, respectively. However, celecoxib was associated with a slight increase in QALY gain and significantly lower incidence of gastrointestinal events (p<.001), with mean incremental cost-effectiveness ratio of €13,286 per QALY gained and €4,471 per event averted. Sensitivity analyses were robust, and confirmed the results of the base case. CONCLUSION: Celecoxib at current price may be considered as a cost-effective alternative vs. non-selective non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis in daily practice in the Spanish NHS.

[Standard error of measurement: an alternative to minimally important difference to access changes in patient-reported-health-outcomes]. / El error estándar de medida: ¿una alternativa a la diferencia mínimamente importante para evaluar cambios en las medidas de salud autopercibida?

OBJECTIVE: To assess the concordance level between the standard Error of Measurement (EEM) and the minimal important difference (MID) criteria when evaluating the magnitude of change in self-perceived health status due to a clinical intervention. METHOD: Two scales of patient self-reported health are used [a measure of benign prostatic hyperplasia impact (BPH-PIM) and a life satisfaction scale (LISAT-8)] in two independent studies carried out in order to adapt each scale to Iberian Spanish population. These studies included 129 and 537 males with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), respectively. After computing EEM and MID values, patients where classified in three groups attending to each criterion: improvement, without change, and worsening. Cohen s kappa agreement index and Kendall s tau-b lineal correlation coefficient where used to assess the level of concordance between criteria. RESULTS: The concordance level between EEM and MID criteria was found to be high for both scales: kappa agreement index attained values of 0.81 and 0.76, while tau-b correlation coefficient attained values of 0.87 and 0.79. CONCLUSION: The agreement level found allows to state that the EEM criterion is an adequate alternative to the MID criterion when assessing the magnitude of change produced in patient reported health.