OBJECTIVES:However, DMARDs are in the first choice in the treatment of rheumathoid arthritis (RA), several patients still take NSAIDs, although, these drugs may cause serious gastro intestinal (GI) side-effects under continuous use. COX2 inhibitors supposed to have a better GI side-effect profile. The aim of our study was to evaluate the cost- effectiveness of the selective COX2 inhibitor, celecoxib compared to conventional NSAIDs and NSAID+PPI combination therapy. METHODS:A decision tree model was developed, for one year, to simulate cohorts within the three arms (celecoxib, NSAIDs, NSAID+PPI). Medical costs, the costs of the side-effects (GI, cardio-vascular (CV) events) and QALYs were calculated to gain ICER. One-way deterministic sensitivity analyses were applied (tornado diagrams). Evaluations were made from a third party payer’s perspective. RESULTS:The results show that both NSAID+PPI (ICER: €14,287/QALY) and celecoxib (ICER: €59,486/QALY) offers extra health gain for extra money compared to NSAIDs. NSAID+PPI seems to be the cost effective choice compared to NSAID mono therapy. Celecoxib was dominated by NSAID+PPI combination therapy. According to the sensitivity analyses QALYs had the highest influence on ICER. CONCLUSIONS:The selective COX2 inhibitor celecoxib seems to be an adequate choice only for a limited group of patients with specific conditions such as drug allergy or serious GI risk with no CV risk, possibly with further PPI co-therapy.