The National Institute of Clinical Excellence (NICE) is conducting an appraisal of the new COX-II specific inhibitors (celecoxib and rofecoxib). NICE asked the Primary Care Rheumatology (PCR) society to comment on the ‘real-life’ clinical- and cost-effectiveness of the COX-II specific inhibitors against NSAIDs and the COX-II selective inhibitors (etodolac and meloxicam) in the treatment of arthritis. This poster summarises the findings of the PCR’s NICE submission. OBJECTIVES: To use evidence-based medicine to compare the ‘real-life’ clinical- and cost-effectiveness of the COX-II specifics versus NSAIDs and the COX-II selectives, in the treatment of arthritis and prevention of drug-related gastro-intestinal (GI) adverse events in primary-care. METHODS: Using PubMed, a literature review of NSAIDs, COX-II inhibitors (celecoxib, etodolac, meloxicam and rofecoxib) and ‘best-practice’ guidelines in the treatment of arthritis was undertaken. The review concentrated on the problems of NSAID-related GI adverse events, their associated treatment costs and whether COX-II inhibitors provide alternative, clinically- and cost-effective methods of treating arthritis. RESULTS: NSAID-related GI risk rises significantly with patient age. In the UK, NSAID-related deaths average 2,600 patients annually. The mean, NHS cost of NSAID-related, GI adverse events is an extra £48 per NSAID patient per year. COX-II specifics have significantly better GI tolerability to NSAIDs. But COX-II specifics cost the NHS an extra £40.15 minimum annually for the average NSAID patient. COX-II selectives are cheaper than COX-II specifics and have significantly higher GI tolerability than NSAIDs. CONCLUSIONS: COX-II inhibitors represent a more clinically effective solution for treating arthritis and reducing GI adverse events in primary care than NSAIDs. There is a lack of ‘real-life’ evidence to determine for which at risk patients COX-II specifics are cost-effective over the COX-II selectives and NSAIDs. Best-practice guidelines support the view that there is a role for COX-II specifics, COX-II selectives and NSAIDs in treating arthritis in primary-care.