Might money spent on statins be better spent?

Previous reports (1-3) have shown that a simplified cost
effectiveness analysis can be useful to interpret the national data of
drug prescription and to establish an index that ranks the "economic
appropriateness" for specific drug classes. Step after step, the various
analyses published by our group in the eBMJ over the past months have
devised some improvements of this method, particularly with regard to
optimising the comparison between the innovative drug and the reference
agent (i.e. how to handle the presence of a comparator).

We initially calculated the index of "economic appropriateness" for
coxibs, given in osteoarthritis or rheumatoid arthritis (3), using a
preliminary version of our method [results: expected health gain, EHG =
24,100 years; real health gain, RHG = 2,601 years or 900 years depending
on whether the clinical data were obtained from Spiegel et al (4) or
Maetzel et al. (5), respectively]. After the methodological improvements
introduced with our subsequent analyses, we would like to recompute this
index using the final version of our method, wherein the presence of the
comparator (in this case: naproxen) is handled more accurately.

In our revised calculation, the value of RHG remains unchanged, while
the value of EHG varies. In Italy, the expenditure for coxibs in 2002
has been 241 million Euros (corresponding number of defined daily doses,
DDDs = 219 millions). The cost of the same number of DDDs using naproxen
is 70 million Euros (cost of a DDD of naproxen = 0.32 Euros). Hence, the
use of coxibs in replacement for naproxen implies an incremental
expenditure of 171 million Euros. According to these data, the health
gain expected from coxibs (i.e. the value of EHG) is 171,000,000/10,000 =
17,100 years or quality-adjusted life years.

In conclusion, the index of economic appropriateness of coxibs
according to our revised calculation is based on EHG=17,100 years vs RHG =
2,601 years or 900 years (depending on whether the clinical data are
obtained from Spiegel et al (4) or Maetzel et al. (5), respectively).
Our initial analysis had found an unfavourable pharmacoeconomic result for
coxibs. After completing this revised calculation, the index of coxibs
improves to some extent, but remains largely unfavourable. Further
applications of this method to other drug classes are currently being
explored to offer as many examples as possible of use of this method.

REFERENCES

1. Messori A et al. Economic appropriateness of the expenditure for
alendronate: cost-effectiveness analysis of national prescription data in
Italy. http://bmj.com/cgi/eletters/327/7406/89#40333

2. Messori A et al. Spending on statins.
http://bmj.com/cgi/eletters/327/7420/933-b#38400

3. Messori A et al. Economic appropriateness of the expenditure for
coxibs: cost-effectiveness analysis of national prescription data in
Italy. http://bmj.com/cgi/eletters/327/7420/933-b#39700

4. Spiegel BM, Targownik L, Dulai GS, Gralnek IM. The cost-
effectiveness of cyclooxygenase-2 selective inhibitors in the management
of chronic arthritis. Ann Intern Med. 2003 May 20;138(10):795-806.

5. Maetzel A, Krahn M, Naglie G. The cost effectiveness of rofecoxib
and celecoxib in patients with osteoarthritis or rheumatoid arthritis.
Arthritis Rheum. 2003 Jun 15;49(3):283-92

Competing interests:
None declared