ESTIMATED COST EFFECTIVENESS OF LOWER-DOSE SUBMICRON DICLOFENAC COMPARED WITH TRADITIONAL DICLOFENAC IN BRAZIL

Author(s)

Mladsi DM*1;Ronquest N1;Tannus G2;Fonseca M3, Saag K4 1RTI Health Solutions, Research Triangle Park, NC, USA, 2Axia.Bio Consulting, São Paulo, Brazil, 3Federal University of São Paulo / Axia.Bio Consulting, São Paulo, Brazil, 4The University of Alabama at

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to treat pain and inflammation.Despite their effectiveness, concerns exist regarding their safety. Worldwide health authorities, including the Brazilian Society of Rheumatology, (Henrique da Mota et al., 2012) advise that NSAIDs should be prescribed at lower doses and for shorter durations. Effectively lowering NSAID dose without compromising pain relief has been demonstrated in randomized controlled trials of an investigational NSAID, lower-dose submicron diclofenac (LDSD) (Manvelian et al., 2012; Silberstein et al., 2012). The objective of this study was to estimate the potential reduction in risk of NSAID dose-related adverse events (AEs), corresponding savings in health care costs, and the incremental cost-effectiveness of LDSD compared with conventional diclofenac (CD) in Brazil. METHODS: A decision-analytic cost-effectiveness model was developed that considered a subset of potential AEs that may be avoided by lowering NSAID dosage. Prediction equations estimating the relative risk of upper GI bleeding/perforation and major CV events, by diclofenac dosage versus non-NSAID use, were estimated by meta-regressions using data from systematic literature reviews (Odom et al., 2013). Utilities, lifetime costs, and health outcomes associated with AEs in Brazil were literature based. The model was validated with clinical experts in Brazil. Results were evaluated in one-way and probabilistic sensitivity analyses. RESULTS: The model predicted that LDSD vs CD could reduce the occurrence of modeled gastrointestinal events (by 18%), cardiovascular events (by 7%), and acute renal failure (by 19%), leading to a 10% reduction in costs of treating AEs. LDSD was predicted to be cost-effective, with a robust incremental cost-effectiveness ratio relatively insensitive to parameter uncertainty. CONCLUSIONS: LDSD has the potential to provide clinical and economic value to patients using NSAIDs in Brazil. Further investigation regarding the potential effect of LDSD on the risk of additional NSAID dose-related toxicities should be explored.

Conference/Value in Health Info

2013-09, ISPOR Latin America 2013, Buenos Aires, Argentina

Value in Health, Vol. 16, No. 7 (November 2013)

Code

PMS15

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Musculoskeletal Disorders, Systemic Disorders/Conditions

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