Cost-effective use of NSAIDs: issues pertinent to coxib use in managed care.

The gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) is well established. The management of patients requiring NSAID therapy has been revolutionized by the cyclooxygenase (COX)-2 inhibitors (coxibs), equally efficacious agents that significantly reduce GI complications. The safety advantage of coxibs comes at the expense of higher drug acquisition costs. To make informed decisions regarding the "value" of these added expenditures, a careful analysis of the clinical and economic impact of these new agents is warranted. This article focuses on the issues pertinent to healthcare payers as they evaluate the coxibs, and provides a review of the studies that calculate the cost-effectiveness of these innovative drugs in a number of patient populations and health systems.