[Analysis of cost-minimization treatment with paracetamol or COX-2 inhibitors (rofecoxib) for pain from arthrosis of the knee or hip]. / Análisis de minimización de costes del tratamiento del dolor en la artrosis de rodilla o cadera con paracetamol o inhibidores de la COX-2 (rofecoxib).

OBJECTIVE: To assess the efficiency of paracetamol, indicated in first instance for light-to-moderate pain from hip and knee arthrosis, against rofecoxib, the COX-2 inhibitor most commonly used in Spain. DESIGN: Pharmaco-economic model: cost-minimisation analysis based on the information provided by a systematic review of the literature. SETTING: Spain: statewide. PARTICIPANTS: Patients with a diagnosis of knee or hip arthrosis, who demand health-care for light-to-moderate pain in the primary care services and present no counter-indication to the treatments under evaluation. MAIN MEASUREMENTS: Given the supposition of the equivalent efficacy of paracetamol and rofecoxib, the cost-minimisation model focused on the cost arising from the adverse side effects caused by the 2 drugs. A correction factor allowed for the number of subjects in the studies reviewed and the number of adverse side effects found. RESULTS: Paracetamol was cheaper than rofecoxib at both 3 months and 1 year. The average cost of paracetamol per year was 307.95 Euros (301.57-315.12) versus 574.59 Euros (566.74-580.40) for rofecoxib treatment. The main cause of costs after the sensitivity analysis was the cost of acquiring the drugs, rather than the rate of incidence of adverse side effects. CONCLUSIONS: In terms of economic analysis based on cost minimisation, paracetamol was the first-preference treatment over rofecoxib for light-to-moderate arthrosis pain. This confirmed the recommendations which, under efficacy and safety criteria, are indicated in various clinical practice guidelines in force.

Análisis de minimización de costes del tratamiento del dolor en la artrosis de rodilla o cadera con paracetamol o inhibidores de la COX-2 (rofecoxib) / Analysis of Cost-Minimisation Treatment With Paracetamol or COX-2 Inhibitors (Rofecoxib) for Pain From Arthrosis of the Knee or Hip

Objetivo. Evaluar la eficiencia de paracetamol, indicado como tratamiento de primera línea para el dolor entre leve y moderado de la artrosis de cadera y rodilla, frente a rofecoxib, el inhibidor de la COX-2 más utilizado en España. Diseño. Modelo farmacoeconómico: análisis de minimización de costes basado en la información proporcionada por la revisión sistemática de la bibliografía. Emplazamiento. Nacional. España. Participantes. Pacientes con diagnóstico de artrosis de rodilla o cadera, con dolor entre leve y moderado, que demandan atención sanitaria en los servicios de atención primaria y que no presentan contraindicación para los tratamientos evaluados. Mediciones principales. Ante el supuesto de una eficacia equivalente entre paracetamol y rofecoxib, el modelo de minimización de costes se centró en el coste originado por la presencia de efectos adversos con cada fármaco tras aplicar un factor de corrección proporcional al número de sujetos incluidos en los estudios revisados y al número de efectos adversos observado. Resultados. El paracetamol minimiza los costes a los 3 meses y a 1 año respecto a rofecoxib. El coste anual promedio de paracetamol es de 307,95 euros (rango, 301,57-315,12) frente a los 574,59 euros (rango, 566,74-580,40) del tratamiento con rofecoxib. El principal inductor de costes tras el análisis de sensibilidad fue el coste de adquisición de los medicamentos, más que la tasa de incidencia de los efectos adversos. Conclusiones. El paracetamol es la primera opción de tratamiento frente a rofecoxib en el dolor artrósico entre leve y moderado desde el punto de vista del análisis económico basado en la minimización de costes, lo que confirma las recomendaciones que, con criterios de eficacia y seguridad, se indican en diversas guías de práctica clínica vigentes (AU)

Objective. To assess the efficiency of paracetamol, indicated in first instance for light-to-moderate pain from hip and knee arthrosis, against rofecoxib, the COX-2 inhibitor most commonly used in Spain. Design. Pharmaco-economic model: cost-minimisation analysis based on the information provided by a systematic review of the literature. Setting. Spain: statewide. Participants. Patients with a diagnosis of knee or hip arthrosis, who demand health-care for light-to-moderate pain in the primary care services and present no counter-indication to the treatments under evaluation. Main measurements. Given the supposition of the equivalent efficacy of paracetamol and rofecoxib, the cost-minimisation model focused on the cost arising from the adverse side effects caused by the 2 drugs. A correction factor allowed for the number of subjects in the studies reviewed and the number of adverse side effects found. Results. Paracetamol was cheaper than rofecoxib at both 3 months and 1 year. The average cost of paracetamol per year was e307.95 (301.57-315.12) versus e574.59 (566.74-580.40) for rofecoxib treatment. The main cause of costs after the sensitivity analysis was the cost of acquiring the drugs, rather than the rate of incidence of adverse side effects. Conclusions. In terms of economic analysis based on cost minimisation, paracetamol was the first-preference treatment over rofecoxib for light-to-moderate arthrosis pain. This confirmed the recommendations which, under efficacy and safety criteria, are indicated in various clinical practice guidelines in force (AU)