Cost-effectiveness of generic celecoxib in knee osteoarthritis for average-risk patients: a model-based evaluation

Osteoarthritis Cartilage. 2018 May;26(5):641-650. doi: 10.1016/j.joca.2018.02.898. Epub 2018 Mar 2.


Objective: The cost-effectiveness of the recently-introduced generic celecoxib in knee OA has not been examined.

Method: We used the Osteoarthritis Policy (OAPol) Model, a validated computer simulation of knee OA, to evaluate long-term clinical outcomes, costs, and cost-effectiveness of generic celecoxib in persons with knee OA. We examined eight treatment strategies consisting of generic celecoxib, over-the-counter (OTC) naproxen, or prescription naproxen, with or without prescription or OTC proton-pump-inhibitors (PPIs) to reduce gastrointestinal (GI) toxicity. In the base case, we assumed that annual cost was $130 for OTC naproxen, $360 for prescription naproxen, and $880 for generic celecoxib. We considered a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) and discounted costs and benefits at 3% annually. In sensitivity analyses we varied celecoxib toxicity, discontinuation, cost, and pain level.

Results: In the base case analysis of the high pain cohort (WOMAC 50), celecoxib had an incremental cost-effectiveness ratio (ICER) of $284,630/QALY compared with OTC naproxen. Only under highly favorable cost, toxicity, and discontinuation assumptions (e.g., annual cost below $360, combined with a reduction in the cardiovascular (CV) event rates below baseline values) was celecoxib likely to be cost-effective. Celecoxib might also be cost-effective at an annual cost of $600 if CV toxicity were eliminated completely. In subjects with moderate pain (WOMAC 30), at the base case CV event rate of 0.2%, generic celecoxib was only cost-effective at the lowest plausible cost ($190).

Conclusion: In knee OA patients with no comorbidities, generic celecoxib is not cost-effective at its current price.

Keywords: Celecoxib; Cost-effectiveness; NSAIDs; Osteoarthritis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Celecoxib / economics
  • Celecoxib / therapeutic use*
  • Computer Simulation*
  • Cost-Benefit Analysis
  • Drug Costs*
  • Drugs, Generic / administration & dosage*
  • Drugs, Generic / economics
  • Female
  • Humans
  • Male
  • Osteoarthritis, Knee / drug therapy*
  • Osteoarthritis, Knee / economics
  • Treatment Outcome


  • Drugs, Generic
  • Celecoxib