1017. Economic Analysis of VA Criteria for Use of Cyclooxygenase-2 Inhibitors
Dennis W Raisch, PhD, Pharmaceutical Management and Research VA Cooperative Studies Program, Albuquerque NM, CL Harris, Pharmaceutical Management and Research VA Cooperative Studies Program, Albuquerque NM

Objectives: To assess the cost impact of applying VA PBM criteria for use of cyclooxygenase 2 inhibitors (COX-2 Criteria) at 3 VISN 18 VA medical centers.

Methods: The COX-2 Criteria can be used to assess risk of gastrointestinal (GI) complications among patients receiving nonsteroidal anti-inflammatory drugs (NSAIDs) and recommend therapies to decrease GI complications. We obtained demographic data, prescribing information, GI hospitalizations, and active problem lists for patients receiving NSAIDs. We determined the GI risk and assessed therapy for each patient. From the perspective of the VA, we modeled the economic impact of improving NSAID therapy. Our model included the VA drug costs and estimated savings from GI-hospitalizations avoided.

Results: We identified 19,122 NSAID users with the following risk factors: 214 previous GI-hospitalizations, 237 on warfarin, 725 on corticosteroids, and 583 with rheumatoid arthritis. Patient risk levels were: substantial (1483, 7.8%) and significant (4643, 24.3%). Most patients (4544, 74.2%) were not receiving therapy according to COX-2 criteria. NSAID drug costs (2002) were $471,898 for these high-risk patients. We modeled 3 alternative therapies: (1) adding a proton pump inhibitor (PPI) to the current NSAIDs, $572,809; (2) switching to a lower cost NSAID with a PPI, $367,433; and (3) changing to a COX-2 inhibitor, cost $1,683,686. We estimated $294,000 savings for 14.7 hospitalizations avoided.

Conclusions: Changing therapy could result in savings of $193,089 or $398,464 or a cost increase of $917,788. Sensitivity analyses verified these results.

Impact: Applying the COX-2 criteria may result in a cost savings and improved health for veterans.