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Traditionelle NSAID-præparater vs COX-2 hæmmere

Traditionelle NSAID-præparater vs COX-2 hæmmere. Baggrund Formål Forudsætninger Model. Resultater Sensitivitetsanalyse Konklusion Diskussion. Introduktion. NSAID smertelindrende effekt flere bivirkninger fra mave-tarm kan reduceres med PPI billigere. COX-2 hæmmere

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Traditionelle NSAID-præparater vs COX-2 hæmmere

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  1. Traditionelle NSAID-præparater vsCOX-2 hæmmere MPH - Maj 2004

  2. Baggrund Formål Forudsætninger Model Resultater Sensitivitetsanalyse Konklusion Diskussion Introduktion MPH - Maj 2004

  3. NSAID smertelindrende effekt flere bivirkninger fra mave-tarm kan reduceres med PPI billigere COX-2 hæmmere samme smerte-lindrende effekt færre bivirkninger fra mave-tarm dyrere Baggrund MPH - Maj 2004

  4. Formål • Hvad kan bedst betale sig, når patienter skal symptomlindres - skal lægerne ordinere NSAID eller COX-2 hæmmere ved smerter? MPH - Maj 2004

  5. Forudsætninger • Målgruppe: 70 + år • NSAID præparat: Ibuprofen • COX-2 hæmmere: Celecoxib • PPI: Lanzoprazol • Tidsperspektiv: 6 måneder • Bivirkninger: efter 3 måneder MPH - Maj 2004

  6. Model Model MPH - Maj 2004

  7. Resultater • ICER ved behandling med COX-2 hæmmere: 2399.63 - 1069.14 / 0.00277 - 0.00146 = 814.000 kr. / QALY MPH - Maj 2004

  8. Sensitivitetsanalyse • Ved valg af dyreste Ibuprofen(NSAID) og COX-2 hæmmer, er der ikke en væsentlig forskel på ICER: 909.000 kr. / QALY • Ved ændring i bivirkningshyppigheden ved NSAID til 75% (ifht. 35%) er ICER: 76.000 kr. / QALY MPH - Maj 2004

  9. Konklusion • Det er ikke omkostningseffektivt at behandle med COX-2 hæmmere -analysen peger på NSAID som det sundhedsøkonomisk optimale valg • Hvis større bivirkningshyppighed ved behandling med NSAID, vil behandling med COX-2 hæmmere være omkostningseffektivt MPH - Maj 2004

  10. Diskussion • Styrker • Svagheder • Valg af målgruppe • ASA • QALY/livskvalitet MPH - Maj 2004

  11. Diskussion h MPH - Maj 2004

  12. Gruppen • Hanne Rasmussen • Hanne Tårup • Lisbet Gamborg • Lise Bjørn Jacobsen • Jeanett L. Péronard MPH - Maj 2004

  13. Referencer 1. P.C. Gotzsche. Non-steroidal anti-inflammatory drugs. BMJ 320 (7241): 1058-106, 2000.J.L. Goldstein, F.E. Silverstein, N.M. Agrawal, R.C. Hubbard, 2. J.Kaiser, C.J. Maurath, K.M. Verburg, G-S. Geis. Reduced risk of upper gastrointestinal ulcer complicatios with celecoxib, a novel COX-2 inhibitor. Am. J. Gastroenterol. 95 (7): 1681-1690, 2000 3. L. Laine. Approaches to non-steroidal anti-inflammatory drugs use in the high-risk patient. Gastroenterology 120 (3): 594-606, 2001 4. G.L.A. Rodriguez. Non-steroidal anti-inflammatory drugs, ulcers and risk: a collaborative meta-analysis. Seminars in Arthritis and Rheumatism 26 (6 Supplement 1): 16-20. 1997 5. G.A. Fitzgerald and C. Patrono. The coxibs, selective inhibitors of cyclooxygenase-2. N. Eng. J. Med. 345 (6): 433-442, 2001. 6. L. Knott. Treating ostroarthritis in practice – The Top Study. Curr Med. Res. Opin. 16 (2); 147-152. 2000 7. J.M. Seager, D.J. Cullen, G. Pearson, S. Holmes, M. Doherty, J.V. Wilson, P. Garrud, S. Garner, A. Maynard, R.F. Logan, 8. C.J. Hawkey. Ibuprofen versus other non-steroidal anti-inflammatory drugs: use in general practice and patients perception. Aliment. Pharmacol. Ther. 14 (2): 187-191, 2000. 9. M.J. Langman, J.Weil, P. Wainwright, D.H. Lawson, M.D. Rawlins, R.F. Logan, M. Murphy, M.P. Vessey, D.G.Colin-Jones. Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet 343 (8905): 1075-1078, 1994 10. L.A. Garcia Rodriguez and H. Jick. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammtory drugs. Lancet 343 (8900): 769-772, 1994 MPH - Maj 2004

  14. Referencer 11. M. Bidaut-Rusell and S.E. Gabriel. Adverse gastrointestinal effcts of NSAIDs: consequences and costs. Best Pract. Res. Clin. Gastroenterol. 15 (5): 739-753,2001 12. M.M. Wolfe, D.R. Lichtenstein, G.Singh. Gastrointestinal toxicity of non-steroidal anti-inflammatory drugs. N. Engl. J. Med. 340 (24): 1888-1899, 1999 13. S.E. Gabriel, L. Jaakkimainen, C. Bombardier. Risk for serious gastrointestinal complications related to use of non-steroidal anti-inflamatory drugs. A meta-analysis. Ann. Intern. Med. 115 (10): 787-796, 1991 14. S. Hernandez-Diaz and L.A. Garcia-Rodriguez. Epidemiologic assessment of the safety of conventional non-steroidal antiinflammatory drugs. Am. J. Med. 110 Suppl 3A; 20S-27S, 2001 15. F. Buttgereit, G.R. Burmester, L.S. Simon. Gastrointestinal toxic side effects of non-steroidal anti-inflammatory drugs and cyclooxygenase2-specific inhibitors. Am. J. Med. 110 Suppl 3A; 13S-19S, 2001 16. C.J. Hawkey, J.A. Karrasch, L. Szczepanski, D.G. Walker, A. Barkun., A.J. Swannell, N.D. Yeomans. Omeprazole compared with misoprostol for ulcers associated with non-steroidal anti-inflammatory drugs. Omeprazole versus Misoprostol for NSAID-induces Ulcer Management (OMNIUM) Study Group. N. Engl. J. Med. 338 (11); 727-734, 1998 17. J.J. Deeks, L.A. Smith, M.D. Bradley. Efficacy, tolerability, and upper gastrointestinal safety of celecoxib for treatment of osteoarthritis and rheumatoid arthritis: systematic review of randomised controlled trials. BMJ 325 (7365): 619, 2002 MPH - Maj 2004

  15. Referencer 18. M. Mamdani, P.A. Rochon, D.N. Juurlink, A. Kopp, G.M. Anderson, G. Naglie, P.C. Austin, A. Laupacis. Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2-inhibitors or conventional non-steroidal anti-inflammtory drugs. BMJ 325 (7365): 624, 2002 19. C.J. Hawkey and J.I. Jones. Gastrointestinal safety of COX-2 specific inhibitiors. Gstroenterol. Clin. North. Am. 30 (4): 921-936, 2001 20. H.B. ElSareg, D.Y. Graham, P. Richardson, J.M. Inadomi. Prevention of complicated ulcer disease among chronic users of non-steroidal anti-inflammatory drugs: the use of a nomogram in cost-effectiveness analysis. Arc. Intern, Med. 162 (18): 2105-2110, 2002 21. J. Podenphant [Rofecoxib, a new NSAID preparation with selective COX-2 inhibition]. Ugeskr. Laeger 162 (39), 5233-5236, 2000 22. R. Micklewright, S. Lane, W. Linley, C. McQuade, F. Thomsen, N. Maskrey. Review article: NSAIDs, gastroprotection and cyclo-oxyenase-II-selective inhibitors. Aliment. Pharmacol. Ther. 17 (3): 321-332, 2003 23. J.L. Goldstein, S.Z. Zhao, T.A. Burke, R. Palmer, H. von Allmen, S.C. Henderson. Incedence of outpatient physician claims for upper gastrointestinal symptoms among new users of celecoxib, ibuprofen, ad naproxen in an insured population in the United States. Am. J. Gastroenterol. 98 (12): 2627-2634, 2003 24. J.M. Hansen, J. Hallas, J.M. Lauritsen, P.Bytzer. [NSAID and ulcer complications. An analysis of risk factors]. Ugeskr. Laeger 159 (24): 3787-3791, 1997 MPH - Maj 2004

  16. Referencer 25. F.E. Silverstin, G. Faich, J.L. Goldstein, L.S. Simon, T. Pincus, A. Whelton, R. Makuch, G. Eisen, N.M. Agrawal, W.F. Stenson, A.M. Burr, W.W. Zhao, J.D. Kent, J.B. Lefkowith, K.M. Verburg, G.S.Geis. Gastrointestinal toxicity with celecoxib vs non-steroidal anti-inflammatory drugs for osteroarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 284 (10): 1247-1255, 2000 26. C. Bombardier, L.Laine, A. Reicin, D. Shapiro, R. Burgos-Vargas, B. Davis, R. Day, M.B. Ferraz, C.J. Hawkey, M.C. Hochberg, T.K. Kvien, T.J. Schnitzer. Comparison of upper gastrointestinal toxicity of rofecoxib an naproxen in patients with rheumatiod arthritis. VIGOR Study Group. N. Engl. J. Med. 343 (21): 1520-1528, 2000 MPH - Maj 2004

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