Abstract:
OBJECTIVES:To investigate the cost effectiveness of cyclo-oxygenase-2 (COX 2) selective inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), and the addition of proton pump inhibitors to these treatments, for people with osteoarthritis. DESIGN:An economic evaluation using a Markov model and data from a systematic review was conducted. Estimates of cardiovascular and gastrointestinal adverse events were based on data from three large randomised controlled trials, and observational data were used for sensitivity analyses. Efficacy benefits from treatment were estimated from a meta-analysis of trials reporting total Western Ontario and McMaster Universities (WOMAC) osteoarthritis index score. Other model inputs were obtained from the relevant literature. The model was run for a hypothetical population of people with osteoarthritis. Subgroup analyses were conducted for people at high risk of gastrointestinal or cardiovascular adverse events. Comparators Licensed COX 2 selective inhibitors (celecoxib and etoricoxib) and traditional NSAIDs (diclofenac, ibuprofen, and naproxen) for which suitable data were available were compared. Paracetamol was also included, as was the possibility of adding a proton pump inhibitor (omeprazole) to each treatment. MAIN OUTCOME MEASURES:The main outcome measure was cost effectiveness, which was based on quality adjusted life years gained. Quality adjusted life year scores were calculated from pooled estimates of efficacy and major adverse events (that is, dyspepsia; symptomatic ulcer; complicated gastrointestinal perforation, ulcer, or bleed; myocardial infarction; stroke; and heart failure). RESULTS:Addition of a proton pump inhibitor to both COX 2 selective inhibitors and traditional NSAIDs was highly cost effective for all patient groups considered (incremental cost effectiveness ratio less than pound1000 (euro1175, $1650)). This finding was robust across a wide range of effectiveness estimates if the cheapest proton pump inhibitor was used. In our base case analysis, adding a proton pump inhibitor to a COX 2 selective inhibitor (used at the lowest licensed dose) was a cost effective option, even for patients at low risk of gastrointestinal adverse events (incremental cost effectiveness ratio approximately pound10 000). Uncertainties around relative adverse event rates meant relative cost effectiveness for individual COX 2 selective inhibitors and traditional NSAIDs was difficult to determine. CONCLUSIONS:Prescribing a proton pump inhibitor for people with osteoarthritis who are taking a traditional NSAID or COX 2 selective inhibitor is cost effective. The cost effectiveness analysis was sensitive to adverse event data and the specific choice of COX 2 selective inhibitor or NSAID agent should, therefore, take into account individual cardiovascular and gastrointestinal risks.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Latimer N,Lord J,Grant RL,O'Mahony R,Dickson J,Conaghan PG,National Institute for Health and Clinical Excellence Osteoarthritis Guideline Development Group.doi
10.1136/bmj.b2538subject
Has Abstractpub_date
2009-07-14 00:00:00pages
b2538eissn
0959-8138issn
1756-1833journal_volume
339pub_type
杂志文章abstract:OBJECTIVE:To compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers, healing of existing pressure ulcers, and patient acceptability. DESIGN:Pragmatic, open, multicentre, randomised controlled trial. SETTING:11 hospitals in ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38849.478299.7C
更新日期:2006-06-17 00:00:00
abstract:OBJECTIVE:To study different nutrients and food additives as risk factors for insulin dependent diabetes mellitus in childhood. DESIGN:Prospective case-control study. Parents of the children being studied were asked to fill in a questionnaire regarding the children's frequency of consumption of various foods. Parents ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6735.1302
更新日期:1990-05-19 00:00:00
abstract:OBJECTIVE:To investigate the effect of two different food supplements on body mass index (BMI) in wasted Malawian adults with HIV who were starting antiretroviral therapy. DESIGN:Randomised, investigator blinded, controlled trial. SETTING:Large, public clinic associated with a referral hospital in Blantyre, Malawi. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.b1867
更新日期:2009-05-22 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of dietary antioxidants in the primary prevention of age related macular degeneration (AMD). DESIGN:Systematic review and meta-analysis. DATA SOURCES:Search of seven databases without limits on year or language of publication, and retrieval of references in pertinent reviews an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.39350.500428.47
更新日期:2007-10-13 00:00:00
abstract:OBJECTIVE:To estimate the usefulness of serum concentrations of the complex of trypsin 2 and alpha 1 antitrypsin in diagnosing and assessing the severity of acute pancreatitis in comparison with serum C reactive protein, amylase, and trypsinogen 2 concentrations (reference markers). DESIGN:Markers were measured in con...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7053.333
更新日期:1996-08-10 00:00:00
abstract:OBJECTIVE:To assess the effect of disclosing authors' conflict of interest declarations to peer reviewers at a medical journal. DESIGN:Randomized controlled trial. SETTING:Manuscript review process at the Annals of Emergency Medicine. PARTICIPANTS: Reviewers (n=838) who reviewed manuscripts submitted between 2 June 2...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.l5896
更新日期:2019-11-06 00:00:00
abstract:OBJECTIVE:To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN:Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and ni...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.883
更新日期:1993-04-03 00:00:00
abstract::Current services for those with mental disorders show two trends. Psychiatric services are becoming concentrated on the care of those with "severe mental illness," largely (but unjustifiably) synonymous with chronic psychosis. The retreat of psychiatry from the care of those with non-psychotic mental disorders has hel...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7050.158
更新日期:1996-07-20 00:00:00
abstract:OBJECTIVE:To investigate the association of enteroviruses with motor neurone disease, also known as amyotrophic lateral sclerosis. DESIGN:Analysis by enterovirus polymerase chain reaction of wax embedded material from spinal cords taken at necropsy from subjects with motor neurone disease and from age and sex matched ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6943.1541
更新日期:1994-06-11 00:00:00
abstract:OBJECTIVES:To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.323.7303.24
更新日期:2001-07-07 00:00:00
abstract:OBJECTIVES:To compare the costs of admission to a hospital at home scheme with those of acute hospital admission. DESIGN:Cost minimisation analysis within a pragmatic randomised controlled trial. SETTING:Hospital at home scheme in Leicester and the city's three acute hospitals. PARTICIPANTS:199 consecutive patients ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.319.7224.1547
更新日期:1999-12-11 00:00:00
abstract::The studyA Rodger, V Cambiano, T Bruun, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019;393:2428-38.This project was funde...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.l4915
更新日期:2019-08-27 00:00:00
abstract:OBJECTIVE:To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease. DESIGN:Prospective cohort study. SETTING:The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom. PARTICIPANTS:47,033 men and women living in...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.d4131
更新日期:2011-07-19 00:00:00
abstract:OBJECTIVE:Detailed analysis of primary cutaneous melanoma first diagnosed in Scotland in patients aged 65 and over. DESIGN:Comparison of changing incidence, sex distribution, site, histogenetic type, tumour thickness, and prognosis of all primary cutaneous melanomas in patients aged 65 and over diagnosed in Scotland i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6829.746
更新日期:1992-03-21 00:00:00
abstract::To assess whether calcitonin is important in maintaining the integrity of bone the calcitonin gene of a young male patient with osteoporosis and no detectable plasma concentrations of calcitonin was studied. Genomic Southern blots with various restriction enzymes showed no large abnormalities in his calcitonin gene. G...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,收录出版
doi:10.1136/bmj.298.6682.1215
更新日期:1989-05-06 00:00:00
abstract:OBJECTIVE:To compare blood pressure control, satisfaction, and adherence to drug treatment in patients with treated hypertension followed up by their family physicians either every three months or every six months for three years. DESIGN:Randomised equivalence clinical trial. Settings 50 family practices in south east...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.37967.374063.EE
更新日期:2004-01-24 00:00:00
abstract:OBJECTIVE:To compare the effect on prevalence of diarrhoea and mortality of household based treatment of drinking water with flocculant-disinfectant, sodium hypochlorite, and standard practices in areas with turbid water source in Africa. DESIGN:Cluster randomised controlled trial over 20 weeks. SETTING:Family compou...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38512.618681.E0
更新日期:2005-09-03 00:00:00
abstract:OBJECTIVE:To evaluate the cost effectiveness of acupuncture in the management of chronic headache. DESIGN:Cost effectiveness analysis of a randomised controlled trial. SETTING:General practices in England and Wales. PARTICIPANTS:401 patients with chronic headache, predominantly migraine. Interventions Patients were ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.38033.896505.EB
更新日期:2004-03-27 00:00:00
abstract:OBJECTIVE:To assess the association between macrolide antibiotics prescribing during pregnancy and major malformations, cerebral palsy, epilepsy, attention deficit hyperactivity disorder, and autism spectrum disorder in children. DESIGN:Population based cohort study. SETTING:The UK Clinical Practice Research Datalink...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m331
更新日期:2020-02-19 00:00:00
abstract::Objective To estimate the incidence and prevalence of resistant hypertension among a UK population treated for hypertension from 1995 to 2015.Design Cohort study.Setting Electronic health records from the UK Clinical Practice Research Datalink in primary care.Participants 1 317 290 users of antihypertensive drugs with...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3984
更新日期:2017-09-22 00:00:00
abstract:OBJECTIVE:To determine whether the author's 20.9 lb (9.5 kg) carbon frame bicycle reduced commuting time compared with his 29.75 lb (13.5 kg) steel frame bicycle. DESIGN:Randomised trial. SETTING:Sheffield and Chesterfield, United Kingdom, between mid-January 2010 and mid-July 2010. PARTICIPANTS:One consultant in an...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.c6801
更新日期:2010-12-09 00:00:00
abstract:OBJECTIVE:To assess the costs and health effects of a range of interventions for preventing the spread of HIV and for treating people with HIV/AIDS in the context of the millennium development goal for combating HIV/AIDS. DESIGN:Cost effectiveness analysis based on an epidemiological model. SETTING:Analyses undertake...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38643.368692.68
更新日期:2005-12-17 00:00:00
abstract:OBJECTIVE:To investigate the effect of vitamin A supplementation and BCG vaccination at birth in low birthweight neonates. DESIGN:Randomised, placebo controlled, two by two factorial trial. SETTING:Bissau, Guinea-Bissau. PARTICIPANTS:1717 low birthweight neonates born at the national hospital. INTERVENTION:Neonates...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c1101
更新日期:2010-03-09 00:00:00
abstract:OBJECTIVE: To determine whether the treatment effect of apixaban versus warfarin differs with increasing numbers of concomitant drugs used by patients with atrial fibrillation. DESIGN: Post hoc analysis performed in 2015 of results from ARISTOTLE (apixaban for reduction in stroke and other thromboembolic events in atr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.i2868
更新日期:2016-06-15 00:00:00
abstract::The results of the work of the Edinburgh Rehabilitation Medicine Service in one year were evaluated. Over 1400 new patients were seen, of whom 525 were in hospital at the time. Patients most often referred were those who had had cardiovascular accidents, back pain, lower limb amputations, and head injuries and those c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.297.6648.601
更新日期:1988-09-03 00:00:00
abstract:OBJECTIVE:To measure the prevalence of breast feeding and to examine the value of using information collected on Guthrie cards (used for detecting inherited metabolic disease and hypothyroidism when newborn infants are 7 days old) to calculate this prevalence. DESIGN:Analysis, by geographical area and maternity unit, ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6932.824
更新日期:1994-03-26 00:00:00
abstract:OBJECTIVE:To investigate estimation of calorie (energy) content of meals from fast food restaurants in adults, adolescents, and school age children. DESIGN:Cross sectional study of repeated visits to fast food restaurant chains. SETTING:89 fast food restaurants in four cities in New England, United States: McDonald's...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f2907
更新日期:2013-05-23 00:00:00
abstract:OBJECTIVE:To assess body shape trajectories in early and middle life in relation to risk of mortality. DESIGN:Prospective cohort study. SETTING:Nurses' Health Study and Health Professionals Follow-up Study. POPULATION:80 266 women and 36 622 men who recalled their body shape at ages 5, 10, 20, 30, and 40 years and p...
journal_title:BMJ (Clinical research ed.)
pub_type: 评论,杂志文章
doi:10.1136/bmj.i2195
更新日期:2016-05-04 00:00:00
abstract:OBJECTIVE:To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. DESIGN:Preplanned subanalysis of randomised intervention study. Settting: Jyväskylä Central Hospital, Finland. PARTICIPANTS:243 independently living patients aged 65 years or older admitted to hospital with ...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7269.1107
更新日期:2000-11-04 00:00:00
abstract:OBJECTIVES:Confirmation of breakthroughs in three different malaria chemoprophylactic regimens (chloroquine 300 mg weekly and proguanil 100 mg daily; chloroquine 300 mg weekly and proguanil 200 mg daily; proguanil 200 mg daily) and assessment of compliance. DESIGN:Prospective, randomised multicentre trial. SETTING:Fi...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.307.6911.1041
更新日期:1993-10-23 00:00:00