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Study findings question COX-2 drug cost effectiveness

ST. LOUIS, December 12, 2003 Findings reported in a study published today by The American Journal of Managed Care call into question the cost effectiveness of the new, more expensive COX-2 anti-inflammatory drugs. Using data representing actual clinical practice, researchers sought to validate the rate of co-prescribing of agents used to protect the gastrointestinal tract -- a key assumption made in prior COX-2 cost-effectiveness studies.

COX-2 drugs offer greater protection from adverse gastrointestinal events than lower-cost, traditional nonsteroidal anti-inflammatory drugs, although both types are equally effective in treating pain.

As a result, estimates of COX-2 cost effectiveness assumed based on expert opinion that most physicians prescribing COX-2 drugs would either stop or dramatically reduce their prescribing of a second drug to protect the gastrointestinal system, which occurs approximately 25% of the time when traditional NSAIDs are prescribed.

However, researchers at pharmacy benefit manager Express Scripts discovered many COX-2 prescribing physicians actually continued co-prescribing gastroprotective drugs like proton pump inhibitors or H2 receptor antagonists. In fact, the study found that gastroprotective drug use was actually higher for COX-2 patients than for those taking a traditional NSAID by a margin of 20% vs. 18%.

"These findings call into question the use of expert opinion in estimating practice pattern model inputs prior to a product's use in clinical practice, warranting a re-evaluation of COX-2 cost effectiveness models," said lead author Emily Cox, PhD, of Express Scripts. She and her team had examined medical and pharmacy claims data at a Midwestern preferred provider organization.

"The harm from incorrect assumptions, such as those found in the cost-effectiveness evaluations of COX-2s, is that they undermine the efficient allocation of scarce healthcare resources," added Cox.

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Contact: Derrell Carter
derrell.carter@express-scripts.com
314-702-7584
Express Scripts, Inc.
12-Dec-2003


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