OBJECTIVES: Intermittent celecoxib use reduces drug cost and limits risk of adverse events, but mitigates drug efficacy. The objective of this study was to estimate the cost-effectiveness of continuous versus intermittent celecoxib use among patients with progressive and symptomatic osteoarthritis.

METHODS: Number of flares per patient were derived using graph digitization of a pragmatic clinical trial that assessed the efficacy of continuous versus intermittent celecoxib. Monte-Carlo simulation with bootstrapping was developed using Poisson distribution for treatment over one year. The simulation estimated the proportion of patients for each cumulative number of flares, assumed to be distributed uniformly over the study period. Continuous use patients received 200 mg daily celecoxib and additional 200 mg after flare occurrence; intermittent use patients received 400mg daily celecoxib only when flares occurred. The model also considered additional physician visits, productivity loss, and health utility associated with flares. Risk and cost of hip/knee surgery were considered in a sensitivity analysis. Costs were reported in 2017 Chinese Yuan (¥).

RESULTS: Patients with continuous celecoxib use had 38.5% reduction in flares over one year compared with intermittent use (mean±SE [95% CI]: 6.4±0.03 [6.4, 6.5] vs. 10.5±0.05 [10.4, 10.6]). Continuous use patients had higher total treatment costs (total: ¥8,450 vs. ¥8,233; celecoxib cost: ¥7,218 vs. ¥6,279; physician cost: ¥1,166 vs. ¥1,847; and productivity loss cost: ¥66 vs. ¥107). The incremental cost-effectiveness ratio and cost-utility ratio with continuous use were ¥54 ($8) per flare avoided and ¥202 ($30) per utility gained over one year. Continuous use was dominant over intermittent use when surgery was included in the analysis.

CONCLUSIONS: Continuous celecoxib use appears to be a cost-effective treatment strategy among patients with progressive symptomatic osteoarthritis from Chinese payers’ perspective. With the consideration of increased risk of hip/knee surgery, continuous celecoxib use may be cost saving compared to intermittent celecoxib use.